Fill and Sign the Mississippi Interim Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI       AND       V. NO.             INTERIM JUDGMENT OF COMMITTAL THIS cause came on to be heard on this date on sworn Complaint of       that Respondent       be committed to a private treatment facility for treatment of chemical dependency, and the Court having heard the evidence is of the opinion and so finds that the Complainant has established by clear and convincing proof that the Respondent is under the influence to the extent that if Respondent is served with process Respondent will, in all       of the Court or physically harm Respondent or others, and the       committed and confined, without notice, to a suitable private facility for the       dependant persons. IT IS THEREFORE ORDERED AND ADJUDGED that the Respondent, be, and is hereby committed and confined, without notice, until a hearing, to       ,       ,       , Mississippi       , a private facility for the treatment of chemically dependent persons, to include primary and extended care and to include psychiatric care and medication, if needed and prescribed and ordered by the medical director of the facility; said facilities be and hereby are ordered to release pertinent information to Complainant's attorney as to whether Respondent has executed a Waiver in this cause. IT IS FURTHER ORDERED AND ADJUDGED that the hearing to determine whether this judgment should be made final is scheduled for       ,       a.m./p.m. the       day of       ,       and Respondent may be served with process and served with notice of the time and place of the hearing advising Respondent that if Respondent does not appear, this interim judgment will be made final. IT IS FURTHER ORDERED AND ADJUDGED that the Sheriff of       County is ordered and directed to assist in transporting the Respondent to the facilities, if necessary, at the expense of Complainant. SO ORDERED AND ADJUDGED this the       day of       ,       . _________________________________________ CHANCELLOR