New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction
Form 16a - Order for psychiatric examination
C.P.L. Article 730
FORM 16-a
3/90
ORDER FOR PSYCHIATRIC EXAMINATION
________ COURT OF ________
COUNTY OF ________
________x
PEOPLE OF THE STATE OF NEW YORK, ORDER FOR PSYCHIATRIC
EXAMINATION
- against - Docket No.
Indictment No.
________,
Defendant.
________ x
The above named defendant having been charged with ________, in violation of ________, and the court being of the opinion that the defendant may be an incapacitated person,
NOW, THEREFORE, it is
ORDERED that, pursuant to Article 730 of the Criminal Procedure Law, the Director of Community Mental Health Services or the Director of ________ Hospital for the (County) (City) of ________ shall cause an examination to be made of said defendant to determine whether said defendant, as a result of mental disease or defect, lacks capacity to understand the proceedings against him or her or to assist in his or her defense, and it is further
ORDERED that such examination be conducted in the manner specified in the paragraph checked below (check only one):
1. said defendant, having heretofore been released on bail or on (his) (her) own recognizance and not being in custody, such examination shall be conducted on an outpatient basis, and said defendant is hereby ordered to report for examination at a time and place to be designated by the said Director
2. said defendant, being now in custody, such examination shall be conducted at the place where (he) (she) is being held, unless the Director shall determine that hospital confinement of the defendant is necessary for an effective examination, in which event the (Sheriff) (Commissioner of Correction of the City of New York) is hereby directed to deliver the defendant to a hospital designated by the Director and to hold the defendant in custody therein, under sufficient guard, until the examination is completed, for a period not exceeding thirty (30) days (if the defendant subsequently has been released on bail, the foregoing paragraph (1) shall apply)
and it is further
ORDERED that upon the completion of said examination, reports thereof be submitted by the Director to this Court pursuant to section 730.20, subdivision 5, of the Criminal Procedure Law, and that the Clerk of the Court furnish a copy of said reports to the attorney for the defendant and to the District Attorney.
Dated: ________
_________
Judge or Justice
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Please indicate relevant reason(s) for referral for: |
Art. 730 Eval. |
Probation Referral |
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Disruptive, confused or bizarre behavior |
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Threatening or violent behavior |
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Suicidal behavior |
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Uncooperative with defense counsel |
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Appears dishevelled; not taking care of self |
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Appears not to understand charges or court processes |
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History of past psychiatric problems |
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History of drug or alcohol abuse |
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History of suicidal behavior |
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Extreme or bizarre type of offense |
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Other: |
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Persons who may be contacted for more information, if needed: |
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Judge: |
Phone: |
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Defense Counsel: |
Phone: |
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District Attorney: |
Phone: |
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Probation Officer: |
Phone: |
COMMENTS OF THE COURT (if any) ____________
____________
____________
____________
BAIL CONDITIONS: ____________
____________
RETURN DATE, IF BAILED: ____________
ENDORSEMENTS
____________
Hospitalization of Defendant not in Custody
TO: The above named court
This Court, having directed that the defendant be examined on an out-patient basis by reason of the defendant's being released on bail or on (his) (her) own recognizance, the Director now informs the Court that hospital confinement of the defendant is necessary for an effective examination, for the following reasons: ____________
____________
and designates the following hospital ____________
____________ for such an examination.
Dated: ____________
___________
Signature of Director
The Court having directed that the defendant be examined on an out-patient basis by reason of the defendant's being released on bail or on (his) (her) own recognizance, and the Court having been informed by the Director that hospital confinement is necessary for an effective examination, the Court hereby directs the (Sheriff) (Commissioner of Correction of the City of New York) to take custody of the said defendant and to transfer (him) (her) to ________ Hospital, for such examination, for a period not exceeding thirty (30) days.
Dated: ________
_________
Judge or Justice
____________
Additional Hospital Confinement
To: The above-named court
The Director hereby applies for additional hospital confinement of the defendant for a period not to exceed thirty (30) days, for the following reasons: ____________
____________
Dated: ____________
___________
Signature of Director
The Court being satisfied that a longer period is necessary to complete the examination of the defendant, the Court does hereby authorize hospital confinement of the said defendant for an additional period, not to exceed thirty (30) days, for such examination.
Dated: ________
_________
Judge or Justice
____________
____________
Hospitalization of Defendant in Custody
To: The (Sheriff) (Commissioner of Correction of the City of New York)
The Director hereby determines that hospital confinement of the defendant is necessary for an effective examination and, pursuant to order of the Court herein, directs that you deliver the defendant to ________ Hospital and hold the defendant in custody therein, under sufficient guard, until the examination is completed, but not to exceed the period authorized by the Court.
Dated: ____________
___________
Signature of Director
____________
