New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction
Form 16-b - Examination report
C.P.L. Article 730
FORM 16-b
12/88
EXAMINATION REPORT
(Psychiatric Examination)
________ COURT OF ________
COUNTY OF ________
________x
EXAMINATION REPORT
PEOPLE OF THE STATE OF NEW YORK,
Docket No. ________
- against - Indictment No. ________
________,
Defendant.
________x
I, the undersigned. duly certified pursuant to law as a (qualified psychiatrist) (certified psychologist), having been designated by ________, Director of ________, pursuant to an order signed by Hon. ________, (Judge) (Justice) of the ________ Court, ________ County, dated ________, to examine the above-named defendant, pursuant to Article 730 of the Criminal Procedure Law, to determine if the defendant is an incapacitated defendant, have conducted such examination with due care and diligence.
The nature and extent of the examination was as follows: ____________
____________
____________
I have come to the following opinion as a result of such examination:
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
It is my opinion that the above-named defendant does not as a result of mental disease or defect lack capacity to understand the proceedings against him or her or to assist in his or her own defense.
Dated: ________
_________
Signature
_________
Printed Name
It is my opinion that the above-named defendant is an incapacitated person in that as a result of mental disease or defect, (he) (she) lacks capacity to understand the proceeding against (him) (her) to assist in (his) (her) own defense. My opinion is based on the following:
1. History and clinical summary, including mental status.
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
2. Diagnosis:
3. Prognosis:
4. Reasons for my opinion, specifying those aspects of the proceedings wherein the defendant lacks capacity to understand or to assist in (his) (her) own defense: (Attach additional sheets, if necessary):
Dated: ________
_________
Signature
_________
Printed Name
