INSTRUCTIONS: MICHIGAN ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY (Form PC 665)

This article discusses the form issued by Michigan courts to order placement of an individual with a developmental disability in a facility such as a child caring institution, boarding school, convalescent home, nursing home or home for the aged or a community residential program. This document can be obtained from the website maintained by the Michigan Courts system.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 1: Where indicated, enter the file number.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 2: On the first blank line, enter the name of the individual with a developmental disability.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 3: On line 1, enter the date of the hearing, the judge, and the judge's bar number.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 4: On line 4, enter the name of the guardian for the individual named above.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 5: On line 5, enter the name of the facility from which the individual with a developmental disability requires care and services.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 6: Check the first box on line 8 if executing the necessary application for temporary administrative admission not to exceed 30 days.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 7: Check the second box if executing the necessary application for administrative admission.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 8: Check the third box if executing the necessary application for admission.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 9: Enter the name of the facility on the next blank line.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 10: Enter the date on the next blank line.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 11: Enter the signature of the judge on the next blank line.

Michigan Order For Placement Of Individual With Developmental Disability PC 665 Step 12: Once completed, the form will take effect.