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

Current through Register Vol. 46, No. 28, July 10,
				2024
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
Please indicate relevant reason(s) for referral
								for:
Art. 730 Eval.
Probation Referral
Disruptive, confused or bizarre
								behavior
Threatening or violent behavior
Suicidal behavior
Uncooperative with defense counsel
Appears dishevelled; not taking care of
								self
Appears not to understand charges or court
								processes
History of past psychiatric problems
History of drug or alcohol abuse
History of suicidal behavior
Extreme or bizarre type of offense
Other:
Persons who may be contacted for more information,
								if needed:
Judge:
Phone:
Defense Counsel:
Phone:
District Attorney:
Phone:
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
____________