IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
IN RE: Involuntary Hospitalization of:
Case No. ________- MH -________
ORDER: FOR DETENTION AND HEARING
MOTION FOR INVOLUNTARY HOSPITALIZATION DUE TO NONCOMPLIANCE
[W.Va. Code: §27-5-2(b)(6)]
[FOR HEARING TO BE HELD WITHIN TWELVE HOURS - W.Va. Code: §27-5-2(b)(4)]
On the _______ day of ____________________, 20_____, came the movant, ________________________________,
who is (relationship to Respondent) ____________________________________________, and moved this Court to order that the
above-named Respondent be taken into custody and detained for the purposes of a hearing pursuant to the provisions of West Virginia
Code: § 27-5-2 (b)(6) for the failure or refusal of the Respondent to comply with the terms of the Voluntary Treatment Agreement.
This Court FINDS the motion sets forth facts which are sufficient to meet the requirements for detention, custody and
hearing as provided by West Virginia Code: § 27-5-2(b)(6).
Accordingly, it is ORDERED that the Sheriff of this County shall forthwith take into custody, detain, and thereafter bring
the Respondent before this Court for the purpose of conducting a hearing upon said motion. Inasmuch as the Circuit Court has
previously entered an standing administrative order, to-wit: number ____________, establishing within
_________________County/Circuit a program which assures the safety and humane treatment of respondents while awaiting a
hearing, the hearing shall be held on the ______ day of _________________________, 20 _____, at the hour of
____________________M, no longer than 12 hours after entry of order.
The Clerk shall enter the foregoing as of the date first above written and transmit attested copies thereof to the Sheriff of
this County, to ______________________________ Mental Health Center/Treatment Provider, Prosecuting Attorney, and to the
Respondent's counsel of record in this matter.
Enter date and time of entry of order:
MAGISTRATE / MENTAL HYGIENE COMMISSIONER / CIRCUIT JUDGE
SCA-MH 907E / 5-01