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IN THE CIRCUIT COURT OF _______________________ COUNTY, WEST VIRGINIA IN RE: Involuntary Hospitalization of Case No. _____________- MH -_____________ ___________________________________________ RESPONDENT REPORT OF DISCHARGE OF INVOL UNTARILY HOSPITALIZED PATIENT [W.Va. Code: §§ 27-7-1, 2, and 3] Pursuant to the provisions of West Virginia Code: § 27-7-1, 2, and 3, comes _ __________________________ [i nsert name of Chief Medical Officer] ___________________ the Chief Me dical Officer of ________________________________________ mental [insert name of mental health facility] health facility and reports: [check applicable provision] ‘ Respondent was a patient at this mental health facility prio r to being placed on convalescent status, has completed six (6) months on convalescent status, and has been discharged from involuntary commitment pursuant to West Virginia Code: § 27-7-2(a). ‘ Respondent can no longer benefit from hosp italization and has been discharged from involuntary commitment pursuant to West Virginia Code : § 27-7-1. Attached is a copy of the patient’s discharge as required by West Virginia Code: § 27-7- 1. ‘ The conditions justifying involuntary hospitalization of the Re spondent no longer exist and Respondent has been discharged from involuntary commitment pursuant to West Virginia Code: § 27-7-1. Attached is a copy of the patient’s discharge as required by West Virginia Code : § 27-7-1. ‘ Respondent was a patient at this mental h ealth facility prior to being released upon request as unimproved into the care of a responsible person, has returned to this mental health facility for examination by this chief medical officer, is no longer in need of hospitalization, has been discharged from involuntary commitment pursuant to West Virginia Code: § 27-7-3. Pursuant to the requirements of West Virginia Code: § 27-7-1, 2, or 3, this Report has been made by this Chief Medical Officer to:  The Circuit Court of Respondent’s county of residence , ___________________________________ County, OR [print name of county] Mental Hygiene Commissione r ______________________________________________ of Respondent’s [print name of Commissioner] county of residence, AND, if different from Respondent’s county of residence:  The Circuit Court of _______________________________ County in which involunt ary hospitalization was or [print name of county] OR Mental Hygiene Co mmissioner _______________________________________________ of the [print name of Commissioner] County in which involuntary hospitalization was ordered. Given under my hand this _________ day of ______________________________________, 2 _______. _________________________________________________________________________ CHIEF MEDICAL OFFICER OF FACILITY C CL MH07 INV 40