PROBATE COURT OF ________________ COUNTY, OHIO
_____________, JUDGE
IN THE INTEREST OF: ______________________________________________________
CASE NO. __________
NOTICE TO RESPONDENT AND
ORDER TO APPEAR FOR EXAMINATIONS AND HEARING
[R.C. 5119.94(B)(3)(4) and (5)]
To:
_______________________
_______________________
_______________________
You are hereby notified that on __________________, ____________________ filed
in this Court a Petition alleging that ____________________________________ is a person
in need of involuntary treatment for alcohol and/or other drug abuse by Court Order. The
Petition is set for a Hearing before this Court at:
Place:________________County Probate Court,___________________________________,
Date: _______________________
Time:_______________________________
_________________________ is to be examined by a Physician for the purpose of a physical
examination and by a Qualified Health Professional for the purpose of a drug and alcohol
addiction assessment and diagnosis no later than 24 hours before the Hearing. These
examinations will be held at:
Place:____________________________________________________________________,
Date: _______________________
Time:_______________________________
You are hereby ordered to appear at both the Court hearing and the examinations.
You are hereby notified that you have the following rights:
*You may retain counsel. If you are indigent, you may be represented by Court-
appointed counsel upon request.
*You have the right to obtain an independent expert evaluation for the purpose
of a physical examination for a drug and alcohol addiction assessment at your
own expense.
FORM 26.5 – NOTICE TO RESPONDENT AND ORDER TO APPEAR FOR EXAMINATIONS AND HEARING
Effective Date: July 1, 2016