Participation Agreement

PARTICIPATION AGREEMENT, ACKNOWLEDGMENT, AND CONSENT FOR DISCLOSURE OF CONFIDENTIAL INFORMATION 

 I, ______________________ in consideration of possible admission to the Lenawee County Enhanced Treatment Court, acknowledge that the offense(s) I committed are related to a diagnosis of mental illness, and that I must admit responsibility for the violation(s).

 I also hereby waive my right to a speedy trial, the right to representation at Enhanced Treatment Court review hearings by an attorney, and my right to a preliminary examination. 

I also agree to participate in Enhanced Treatment Court and to comply with all of its rules, as set forth in the attachment to this Agreement. 

I realize that failure to complete the program may result in a Probation Violation, which may subject me to the full penalties of the conviction. 

As a participant in Enhanced Treatment Court, I consent to communication between the 2A District Court Enhanced Treatment Court Judge, the State of Michigan parole, probation supervisor, the Lenawee County Prosecutor, treatment providers, defense attorney assigned to Enhanced Treatment Court, the Enhanced Treatment Court Coordinator, the Lenawee County Sheriff, Lenawee County Corrections, or any of their designees. The purpose of and need for this disclosure is to inform the Court and all named parties of my eligibility and/or acceptability for mental health and/or co-occurring substance abuse treatment services and my treatment  attendance, prognosis, compliance, and progress in accordance with the Enhanced Treatment Court program’s monitoring. 

I understand that this consent will remain in effect throughout the course of my involvement with Enhanced Treatment Court. Further, I understand that revocation of the waiver will result in dismissal from the Enhanced Treatment Court program and sentencing pursuant to the law or plea agreement. 

I expressly waive any and all rights of confidentiality and privacy that I may have under 45 CFR parts 160 and 164 commonly known as HIPAA and 42 CFR Part 2 as well as the State of Michigan equivalent statutes regarding confidentiality and privacy for substance abuse treatment providers as needed for monitoring Enhanced Treatment Court participation. Specifically, I acknowledge that the Court’s legal file will contain references to Enhanced Treatment Court, and that I am aware that Enhanced Treatment Court hearings are open to the public. 

I further agree to hold participants in the Enhanced Treatment Court team harmless for any damages resulting in their participation in the 2A District Court Adult Enhanced Treatment Court. 

Participant:  _____________________        ______________________     ___________
                        (print name)                                              (signature)                        (date)

 

I waive the right to review this agreement with an attorney prior to signing:

Participant:  _____________________        ______________________     ___________
                        (print name)                                            (signature)                            (date)

  OR
I have reviewed this with the participant prior to signing:

Attorney: 
    _____________________        ______________________     ___________
                        (print name/P Number)                    (signature)                                 (date)