Michigan probate courts use the PCM 208a when an individual on an assisted outpatient or combined treatment order appeals a return from authorized leave to a hospital or facility (MCR 5.743a). A clinician meets it when the hospital needs to justify the return. Attached to the clinician's PCM 208 clinical certificate, it explains why the individual came back, the treatment plan, and alternatives the court could order instead.
A physician, psychiatrist or licensed psychologist completes the whole one-page supplement and signs under the penalties of perjury.
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Supplement to Clinical Certificate on Appeal of Return to Hospital/Facility
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When an individual under an assisted outpatient treatment or combined order is returned from authorized leave to a hospital or facility and appeals that return. The examiner supplements the PCM 208 clinical certificate with the reasons for the return and the plan for further treatment.
Alternatives the court could consider if it rules against the return, instead of simply going back to authorized leave. The form lists options such as residential placement, day treatment, home care and assisted outpatient treatment, or the examiner states why none merits exploration.