IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
IN RE: Involuntary Hospitalization of:
Case No. ________- MH -________
ORDER: FOR HEARING AND NOTICE
MOTION TO CANCEL OR MODIFY VOLUNTARY TREATMENT AGREEMENT
[W.Va. Code: §27-5-2(h)]
On the _______ day of ____________________, 20______, came the Respondent and moved this Court to order that the
Voluntary Treatment Agreement be canceled or modified.
Accordingly, it is ORDERED that a hearing on the matters contained in the motion shall be held on the ________ day of
_________________________, 20 _______, and that such hearing shall be held at [insert location of hearing] ________________
further, that the Clerk of this Court shall mail this Order and Notice, together with a copy of the motion hereinbefore filed, upon
____________________________________________________ Mental Health Center, the Respondent, Respondent's counsel of
record in this matter, the Applicant, and counsel of record/appearing for Applicant, if any .
The Clerk shall enter the foregoing as of the date first above written.
MENTAL HYGIENE COMMISSIONER / CIRCUIT JUDGE / MAGISTRATE
SCA-MH 907I /6-06