REQUEST TO RETURN ESCAPEE OR CONDITIONAL RELEASEE
STATE OF NORTH CAROLINA REQUEST TO RETURN ESCAPEE OR CONDITIONAL RELEASEEDepartment of Health and Human ServicesDivision of Mental Health, Developmental Disabilities, and Substance Abuse ServicesDISTRIBUTION WHEN REQUEST TO RETURN IS ISSUED:Nursing Staff: HIM (original copy) Official placing patient on detainer Initial examiner if involuntarily committed Area program (if appropriate) Next of kin/legally responsible partyAny law enforcement office notified Clerk of Superior Court in county of commitmentDMH 5-82-02 REQUEST TO RETURN ESCAPEE OR CONDITIONAL RELEASEERevised September 2001DATE: ______ TO: __________________________________ FROM: ________________________________
STATE OF NORTH CAROLINA REQUEST TO RETURN ESCAPEE OR CONDITIONAL RELEASEE Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
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