Fill and Sign the Mental Hygienethe Wv Young Lawyers Section Form

IN THE CIRCUIT COURT OF ________________ COUNTY, WEST VIRGINIA IN RE: Involuntary Hospitalization of Case No. ________- MH -________ ___________________________________ RESPONDENT ORDER: MOTION TO CANCEL OR MODIFY VOLUNTARY TREATMENT AGREEMENT [W.Va. Code: §27-5-2(h)] This matter was heard on the __________ day of ___________________________, 20________, the Respondent appearing in person and by appointed counsel, ___________________________________________________________. The following also appeared in person: _______________________________________________________________________\ ____________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ________________________. Testimony was received from ________________________________________________________ Ment al Health Center / Treatment Provider by its representative _____________________________________________ and also from the following individual(s): ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ After hearing the testimony of witnesses and receiving all re levant evidence; upon the arguments of counsel, the Court makes the following FINDINGS: _______________________________________________________________________\ ______________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ _____________________ ______________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ _____________________ ______________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ _____________________ ______________ _____________________________________[ attach additional pages as necessary.] SCA-MH 907J-1 / 6-06 ORDER DECIDING MOTION TO CANCEL OR MODIFY Page 1 of 2 SCA-MH 907J-1 / 6-06 ORDER DECIDING MOTION TO CANCEL OR MODIFY Page 2 of 2 Accordingly, and based upon the foregoing findings, it is hereby ORDERED that the Respondent's Motion to Cancel or Modify the Voluntary Treatment Agreement is, and the same is hereby: [initial appropriate relief ] _________________ Cance llation granted for the reasons set forth below. These proceedings are hereby dismissed. _________________ Modification granted for the reasons contained below. _________________ Denied. The or iginal Treatment Agreement shall remain in full force and effect according to its terms. If this Order grants modification of the Voluntary Treatment Agreement, the same is hereby modified in the following respects: [insert changes to agreement ] ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ___________________________________________________________________ If cancellation is granted, th e reasons are as follows: _________________________________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ___________________________________________________________________ The Clerk shall enter the foregoing ORDER as of the day and date first above written and shall transmit attested copies thereof to the Respondent, Applicant, all counsel of record, and to the ___________________________________________________ Mental Health Center/Treatment Provider. ____________________________________________________________________\ ________ MENTAL HYGIENE COMMISSIONER / CIRCUIT JUDGE /MAGISTRATE