Fill and Sign the Settlement Court Approval Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE CONDITION OF       Name of Subject Settlement Agreement and Court Approval and Order to Transport       Date of Birth Case No.       1. The subject: a. Stipulates to a finding of probable cause as to the criteria under §51.20(1), Wis. Stats., and waives the time period for holding a final hearing for       days. b. Waives the time period for holding a probable cause hearing and a final hearing for       days. c. Waives the time period for holding a final hearing for       days. d. Refuses or is unable to sign the agreement, but agrees to waive time periods for hearings for       days. 2. The subject agrees to comply with the following treatment and conditions for the term of this Agreement: a. Take all prescribed doses of psychotropic medications. b. Keep all appointments with treatment providers and case management staff. c. Cooperate with psychiatric and psychological testing, therapy, and recommendations. d. Keep case management or treatment staff advised of current residential address or location. e. Refrain from acts, attempts or threats of harm to self or others. f. Refrain from ingesting any controlled substances not prescribed for subject. g. Refrain from consuming alcoholic beverages. h. Remain in an inpatient treatment facility until discharged, but not later than       . i. Other:       . 3. Either party may request the court to modify the treatment plan. 4. The subject agrees to waive confidentiality of treatment records to allow monitoring of the subject's compliance. 5. Upon receipt of a sworn statement alleging the subject's failure to comply with this Agreement, the court: a. May issue an order to detain the subject at an approved inpatient treatment facility. b. Shall, upon subject's motion, hold a hearing on the issue of noncompliance with the Agreement within 72 hours of the filing of the motion. c. Shall hold either a probable cause or final hearing, as required. 6. The proceeding will be dismissed on       , if the subject complies with this Agreement. Signature – Subject Signature – Subject‘s Attorney Signature – Corporation Counsel Subject’s Address       Attorney’s Telephone       Attorney’s Telephone       COURT APPROVAL and ORDER TO TRANSPORT The court approves this Agreement and designates the       department established under §51.42 or 51.437, Wis. Stats., to monitor the treatment and compliance. The department shall notify the corporation counsel and subject's attorney of noncompliance. Transportation to the facility shall be provided by the sheriff other:       ME-908 , 12/02 Settlement Agreement and Court Approval and Order to Transport §51.20(8)(bg), (bm), and (br), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Settlement Agreement and Court Approval and Order to Transport Page 2 of 2 Case No. Distribution: 1. Court – Original 2. Subject 3. Subject’s Counsel 4. Corporation Counsel 5. County Dept. Monitoring Agreement 6. Treatment Provider (if different) BY THE COURT: Circuit Court Judge/Circuit Court Commissioner       Name Printed or Typed       Date ME-908 , 12/02 Settlement Agreement and Court Approval and Order to Transport §51.20(8)(bg), (bm), and (br), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2