Michigan probate courts use the PCM 215a when a petition seeks judicial admission of a person with an intellectual disability to a facility under MCL 330.1516. A clinician meets it as one of the examiners asked to certify whether the person meets the criteria. The back page reports the person's condition, available alternatives to admission and the recommended living arrangement, so the court can weigh less restrictive options.
Up to two examining physicians or licensed psychologists complete the Certification of Examiners on the front, each in a separate block with the examination date. The person who evaluated the individual completes the Report on Petition for Judicial Admission on the back.
Download the current version from the source each time; forms change without notice.
Certification and Report on Petition for Judicial Admission
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Whether the individual has an intellectual disability and can reasonably be expected in the near future to seriously physically injure self or others, having overtly acted in a way that supports that expectation, or has been arrested and charged with an offense that resulted from the intellectual disability.
The evaluator's profession and title, the individual's mental, physical, social and educational condition, available alternatives to facility admission with their availability, and a recommended living arrangement by type and location. The report is signed under the penalties of perjury.