In The Superior Court For The State Of Alaska
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1IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT
In the Matter of the Necessity
)
for the Hospitalization of:
)
)
,
)
Case No.
Respondent.
)
)
NOTICE TO OUTPATIENT TO
RETURN TO TREATMENT FACILITY
WHERE COMMITTED
To:
It has been determined that you can no longer be treated at
as an outpatient because you are likely to cause
harm to yourself or others or are gravely disabled.
You must return to the treatment facility to which you were committed,
, at
Alaska, within 24
hours after you receive this notice.
Date
Signature of Provider of Outpatient Care
Printed Name
Title
I certify that on _________________
a copy of this notice was mailed or
delivered to:
court
respondent
respondent's attorney
attorney general
respondent's guardian (if any)
inpatient treatment facility:
By:
Outpatient Care Provider
MC-425 (12/87)(cs)
AS 47.30.795(c)
NOTICE TO OUTPATIENT TO RETURN
TO TREATMENT FACILITY WHERE COMMITTED
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