Fillable AOC-705A KRS 222.435 Court of Justice www.courts.ky.gov Commonwealth (Administrative Office of the Courts)

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AOC-705A KRS 222.435 Court of Justice www.courts.ky.gov Commonwealth (Administrative Office of the Courts)

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WHEREAS, a Veried Petition requesting Involuntary Treatment for a Substance Use Disorder having been led with the
Court; the Court having reviewed the allegations therein and having examined the Petitioner under oath; and it appearing to
the Court that there is probable cause to believe the Respondent should be ordered to undergo treatment for a substance
use disorder or there exists a substantial likelihood of such threat in the near future, and Respondent can reasonably
benet from treatment; and the Court being otherwise suciently advised:
IT IS HEREBY ORDERED that:
1. The Respondent be delivered to __________________________________ (treatment/examination facility),
without unnecessary delay, by the Sheri or other Peace Ocer of this County, to be examined by a licensed
Physician and/or Qualied Health Professional.
2. Following said examination, the licensed Physician and/or Qualied Health Professional shall le a Certication
of ndings with this Court.
3. The transportation costs of the sheri, other peace ocer, ambulance service, or other private agency on contract
with the Cabinet shall be included in the costs of treatment for a substance use disorder to be paid by the
Petitioner.
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AOC-705A
Rev. 6-19
Page 1 of 2
Commonwealth of Kentucky
Court of Justice www.courts.ky.gov
KRS 222.435
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
____________________________________________
Judge's Signature
________________________________, 2______
Date
____________________________________________
Judge's Name (please print)
Attorney's Address:
_______________________________________________
_______________________________________________
_______________________________________________
Telephone Number: ______________________________
( )
****** Petitioner may be required to make any advanced payment necessary to execute this Order.
IN THE INTEREST OF:
RESPONDENT_____________________________________________________
Residence: ____________________________________________
______________________________________________________
Current Location: _______________________________________
______________________________________________________
Telephone Number: ______________________________
( )
SHERIFF TRANSPORT AND
EXAMINATION ORDER
(Involuntary Treatment-Substance Use Disorder)
District
AOC-705A
Rev. 6-19
Page 2 of 2
Distribution: Original – Court File
Copy – Respondent’s Attorney
5 Copies – Peace Ocer
1 - Respondent
2 - Peace Ocer’s le and return
1 - Licensed Physician named above
1 - Qualied Health Professional named above
EXECUTION
Executed by delivering the Respondent to:
________________________________________________________________________________________________
________________________________________________________________________________________________
____________________________________________
Signature/Title
_____________________________, 2_____
Date
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AOC-705A KRS 222.435 Court of Justice www.courts.ky.gov Commonwealth (Administrative Office of the Courts)

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Completed 14 November 2021

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