In the matter of the condition of




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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY

For Official Use



IN THE MATTER OF THE CONDITION OF
     

Name of Subject


Order for Involuntary

Medication and Treatment




     

Date of Birth

Case No.      


THE COURT FINDS AND CONCLUDES:
1. The issue of involuntary administration of medication or treatment was considered at a hearing:
 a. at or after a probable cause hearing. There is probable cause to believe that medication or treatment will have therapeutic value and will not unreasonably impair the subject's ability to prepare for and participate in future court proceedings.
 b. at or after a final hearing. Medication or treatment will have therapeutic value.
2. The subject appeared  in person.  by counsel.
3. The subject needs medication or treatment.
4. The advantages, disadvantages, and alternatives to medication have been explained to the subject.
5. Due to:

 mental illness,

 developmental disability,

 alcoholism,

 drug dependence,

the subject is not competent to refuse psychotropic medication or treatment because:

 the subject is incapable of expressing an understanding of the advantages and disadvantages of accepting medication or treatment and the alternatives; or,

 the subject is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her condition in order to make an informed choice as to whether to accept or refuse psychotropic medications.



THE COURT ORDERS:
Medication and treatment may be administered to the subject, regardless of his or her consent:

 until the final hearing in this matter.

 during the period of commitment, or until further order of the court.



Distribution:

1. Court – Original

2. Parties



3. Treatment Provider





BY THE COURT:








Circuit Court Judge/Circuit Court Commissioner




     

Name Printed or Typed




     

Date




ME-905, 12/02 Order for Involuntary Medication and Treatment § 51.61(1)(g), Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.




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