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ME-922, 04/07 Order Confirming Voluntary Admission §51.13(4), W isconsin Statutes This form shall not be modified. It may be supplemented with additional mater ial. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY 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 A. minor is in need of psychiatric services, or services for developmental disabili ties, alcoholism, or drug abuse; B. facility the minor has been admitted to offers inpatient therapy or tr eatment that is appropriate to the minor’s needs; C. facility is the least restrictive therapy or treatment consistent with t he needs of the minor; D. minor is 14 years of age or older and has been admitted to the facilit y for the primary purpose of treatment for mental illness or developmental disabilities and th e admission was made under an application executed by the minor and the minor’s parent or guardian. IT IS ORDERED: The voluntary admission of the minor is approved. BY THE COURT: DISTRIBUTION: 1. Court 2. Facility 3. Other: Circuit Court Judge Print or Type Name if not eSigned Date