Fill and Sign the With Order for Involuntary Administration of Form

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Amended IN THE MATTER OF Order on Statement of Noncompliance with Order for Involuntary Administration of Psychotropic Medication Name Date of Birth Case No. A Statement of Noncompliance with Order for Involuntary Administration of Psychotropic Medication was filed on . The Court has considered the evidence presented. THE COURT FINDS: 1. An Order for Involuntary Administration of Psychotropic Medication was issued by the Court on . 2. The ward has substantially failed to comply with the administration of psychotropic medication as ordered under the treatment plan. 3. It is necessary for the ward to be transported to facility for forcible restraint for administration of psychotropic medication. or another appropriate THE COURT ORDERS: 1. The sheriff or any other law enforcement agency in the county in which the ward is found or in which it is believed that the ward may be present to take the ward into custody and transport him or her to or another appropriate facility for administration of psychotropic medication using forcible restraint, with consent of the guardian. 2. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. DISTRIBUTION: 1. Court 2. Ward 3. Ward’s Guardian 4. Ward’s Counsel 5. Corporation Counsel 6. Director or Designee of County Dept. which developed and administers treatment plan 7. Treatment Facility/Provider GN-4220, 05/19 Order on Statement of Noncompliance with Order for Involuntary Administration of Psychotropic Medication This form shall not be modified. It may be supplemented with additional material. §55.14(9), Wisconsin Statutes