STATE OF ILLINOIS
IN THE ________________JUDICIAL CIRCUIT
IN THE MATTER OF:
ORDER FOR INVOLUNTARY ADMISSION
THIS MATTER COMING TO BE HEARD ON THE PETITION OF _____________________(Petitioner)
FOR THE INVOLUNTARY ADMISSION OF __________________________(Respondent), AND:
G The Petitioner who initiated this matter pursuant to 405 ILCS 5/3-701 is PRESENT in court
and has received written notice, or waived notice, of his/her rights under 405 ILCS 5/3-902 to
receive notice of the Facility Director’s decision to discharge the Respondent.
G The Petitioner who initiated this matter pursuant to 405 ILCS 5/3-701 is NOT PRESENT in
court and the Clerk of the Court is directed to mail to the Petitioner notice of his/her rights
under 405 ILCS 5/3-902 to receive notice of the Facility Director’s decision to discharge the
G The Respondent is PRESENT in court.
G The Respondent is NOT PRESENT in court and his/her presence is waived by counsel.
G Notice of this hearing has been provided to the Respondent’s guardian and all relevant
persons pursuant to 405 ILCS 5/3-706.
AFTER A HEARING, THE COURT FINDS BY CLEAR AND CONVINCING EVIDENCE THAT: (check all
G A. The Respondent is subject to involuntary admission on an inpatient basis because, in
accordance with Section 1-119 of the Mental Health and Developmental Disabilities Code,
[405 ILCS 5/1-119] (hereinafter “the Code”) he or she is a person with a mental illness
who: (check all that apply)
G 1. Because of his or her mental illness is reasonably expected, unless treated on an
inpatient basis, to engage in conduct placing such person or another in physical harm or
in reasonable expectation of being physically harmed.
G 2. Because of his or her mental illness is unable to provide for his or her basic physical
needs so as to guard himself or herself from serious harm without the assistance of family
or others, unless treated on an inpatient basis.
G 3. (i) Refuses treatment or is not adhering adequately to prescribed treatment; (ii)
because of the nature of his or her mental illness, is unable to understand his or her need
for treatment; and (iii) if not treated on an inpatient basis, is reasonably expected, based
on his or her behavioral history, to suffer mental or emotional deterioration and is
reasonably expected, after such deterioration, to meet the criteria of paragraph (1) or (2)