New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter II - Cpl Section 330.20 Forms › Forms (cf. Part 110) › Form A - Examination order (inpatient examination)

Current through Register Vol. 46, No. 28, July
				  10, 2024
FORM A
EXAMINATION ORDER
(INPATIENT EXAMINATION)
STATE OF NEW YORK
SUPREME COURT COUNTY COURT
PART: ________ COUNTY: ____________
________
PEOPLE OF THE STATE OF NEW YORK
Indictment No. ____________
vs. Crime Charged:
________
Defendant
________
Present:
Honorable ____________
Justice of the Supreme Court
Judge of the County Court
The above-named defendant having been found
					 not responsible by reason of mental disease or defect by verdict (C PL 300.10,
					 subd. 4[d])
by plea (C PL 220.15)
NOW THEREFORE, it is
ORDERED that the said defendant submit to a
					 psychiatric examination to determine whether he she has a dangerous mental
					 disorder, as that term is defined in paragraph (c) of subdivision 1 of C PL
					 330.20, and if the said defendant does not have a dangerous mental disorder, to
					 determine whether he she is mentally ill, as that term is defined in paragraph
					 (d) of subdivision 1 of C PL 330.20, and it is further
ORDERED that the State Commissioner of
					 Mental Health shall designate two qualified psychiatrists to conduct the
					 aforesaid psychiatric examination, except that the Commissioner may, in his
					 discretion, designate one qualified psychiatrist and one licensed psychologist
					 to conduct the aforesaid examination, and such designated psychiatric
					 examiners, in conducting their examination, may employ any method which is
					 accepted by the medical profession or acceptable to licensed clinical
					 psychologists for the examination of persons alleged to be suffering from a
					 dangerous mental disorder or to be mentally ill or retarded, and it is
					 further
ORDERED that a psychiatrist or psychologist
					 retained by the above-named defendant may be present at the aforesaid
					 psychiatric examination, and it is further
ORDERED that the above-named defendant be
					 committed to a secure facility within the State Office of Mental Health which
					 is staffed with personnel adequately trained in security methods and is so
					 equipped as to minimize the risk or danger of escapes, and which has been
					 specifically designated by the State Commissioner of Mental Health as the place
					 for conducting the aforesaid psychiatric examination, and it is further
ORDERED that the continuous confinement of
					 the above-named defendant in the aforesaid secure facility shall be for a
					 period not exceeding 30 days, unless the court, upon application of the State
					 Commissioner of Mental Health, subsequently authorizes confinement for an
					 additional period prescribed by law; provided, however, that if the initial
					 hearing required by subdivision 6 of C PL 330.20 has not commenced prior to the
					 termination of the aforesaid examination period or periods, the State
					 Commissioner of Mental Health shall retain custody of the defendant in such
					 secure facility until custody is transferred in the manner prescribed in
					 subdivision 6 of C PL 330.20, and it is further
ORDERED that the
Commissioner of Correction for the City of
					 New York
Sheriff of ________ County
Commissioner of Correction for
					 ________
shall hold the above-named defendant in
					 custody pending the aforesaid designation by the State Commissioner of Mental
					 Health and when notified of the designation shall promptly deliver the said
					 defendant to such secure facility, and it is further
ORDERED that each psychiatric examiner
					 designated by the State Commissioner of Mental Health to conduct the aforesaid
					 psychiatric examination shall, upon completion of the examination, promptly
					 prepare a report of his or her findings and evaluation concerning the
					 defendant's mental condition and submit such report to the said Commissioner,
					 and upon receipt and review of such report from each designated psychiatric
					 examiner, the said Commissioner shall submit four copies of each such report to
					 the court that issued this examination order.
Dated: ________
____________
Justice of the Supreme Court
Judge of the County Court
Name, Address and Telephone Number of Court
					 Clerk:
________
________
________
________
Name, Address and Telephone Number of
					 District Attorney:
________
________
________
________
Name, Address and Telephone Number of
					 Counsel for Above-named Defendant:
________
________
________
________
Note: The Clerk of the Court must promptly
					 forward or furnish a copy of this examination order to each of the following
					 persons:
1. State
				  Commissioner of Mental Health
2. The above-indicated Sheriff or local
				  Commissioner of Correction
3. Director of the Mental Health
				  Information Service
4. The above-named Defendant
5. Counsel for
				  Defendant
6.
				  District Attorney
Designation of Secure Facility:
The State Commissioner of Mental Health has
					 designated the following secure facility as the place for conducting the
					 psychiatric examination referred to in this order:
____________.
The authority for designating the
					 above-named secure facility is:
[contact Director of Forensic
Services, telephone 518: 474-7275]