N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. II, Forms (cf. Part 110), form A
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:
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]
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. II, Forms (cf. Part 110), form A