Fill and Sign the Order Confirming Voluntary Admission Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT ,       COUNTY For Official Use IN THE MATTER OF:       Name of Subject Order Confirming Voluntary Admission       Date of Birth Case No.       Based upon an allegations of the Petition for Review and any accompanying documents, The Court finds there is a prima facia showing: that the minor is in need of psychiatric services, or services for developmental disabilities, alcoholism, or drug abuse; that the facility the minor has been admitted to offers inpatient therapy or treatment that is appropriate to the minor’s needs; that the facility is the least restrictive therapy or treatment consistent with the needs of the minor; that the minor is 14 years of age or older and has been admitted to the facility for the primary purpose of treatment for mental illness or developmental disabilities and the admission was made under an application executed by the minor and the minor’s parent or guardian. IT IS ORDERED that the voluntary admission of the minor is approved. Distribution: 1. Original - Court 2. Facility 3. Other:       BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date ME-922, 04/07 Order Confirming Voluntary Admission §51.13(4), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.