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PCM 208aMandatory

Supplement to Clinical Certificate on Appeal of Return to Hospital/Facility

Michigan · Michigan State Court Administrative Office · Effective February 1, 2019

This form is a supplement to a clinical certificate used when appealing a return to a hospital or facility. It asks the person filling it out to state the reasons for the person's return and what treatment plans are needed.

The court describes it as: Court rule / statute: MCR 5.743a

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

Appeal

Stage: Appeal

This form is used in a legal situation involving a mental health treatment appeal, specifically when a person is returning to a hospital or facility after authorized leave.

Prepared by the court or clerk.

Common questions

What is this form for?
This form is a supplement to a clinical certificate used when appealing a return to a hospital or facility.
Who fills out this form?
The form requires a signature and title from a physician, psychiatrist, or licensed psychologist.
Does this form require a filing fee?
The provided text does not mention any filing fees.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect February 1, 2019.

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