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Revocation of Provisional Discharge Fact Sheet
I. For persons committed as Mentally Ill, Chemically Dependent or Developmentally
Disabilities
Some people who have been committed may be discharged
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How to fill out revocation of provisional discharge

How to fill out revocation of provisional discharge:
01
Obtain the necessary form: Contact the appropriate authority or organization to obtain the revocation of provisional discharge form. This form may also be available online for download.
02
Fill in personal information: Start by providing your full name, address, contact information, and any other required personal details. Make sure to provide accurate information to prevent any delays or complications.
03
State the reason for revocation: Clearly state the reason why you are requesting the revocation of provisional discharge. This could be due to a change in circumstances, new information, or any other valid reason.
04
Provide supporting documents: Attach any necessary documents or evidence that support your request for revocation. This could include medical records, witness statements, or any other relevant documentation.
05
Sign and date the form: Once you have completed filling out the form, make sure to sign and date it. This is an important step to validate your request.
Who needs revocation of provisional discharge?
01
Individuals granted provisional discharge: Anyone who has been granted provisional discharge, which is a temporary release or permission to leave a certain facility or institution, may need to request revocation if they no longer wish to have this temporary release or if their circumstances have changed.
02
Legal authorities: The revocation of provisional discharge may also be initiated by legal authorities who have granted someone provisional discharge but have determined that it is no longer appropriate or necessary.
03
Family members or guardians: In some cases, family members or court-appointed guardians may need to request the revocation of provisional discharge on behalf of someone who is unable to do so themselves due to physical or mental incapacitation.
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What is revocation of provisional discharge?
Revocation of provisional discharge is the process of canceling or withdrawing a temporary release or permission that was granted to an individual, typically from a medical or legal institution.
Who is required to file revocation of provisional discharge?
The person or entity responsible for the initial provisional discharge is typically required to file for revocation of provisional discharge.
How to fill out revocation of provisional discharge?
To fill out revocation of provisional discharge, the individual or entity must complete the necessary forms provided by the relevant institution, detailing the reasons for the revocation.
What is the purpose of revocation of provisional discharge?
The purpose of revocation of provisional discharge is to revoke the temporary release or permission granted to an individual, typically due to non-compliance or violation of the terms of the discharge.
What information must be reported on revocation of provisional discharge?
The revocation of provisional discharge form typically requires information about the individual's case, reasons for revocation, and any relevant supporting documentation.
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