N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. II, Forms (cf. Part 110), form B
FORM B
EXAMINATION ORDER
(OUTPATIENT 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)
and such defendant not being in custody at the time of such verdict or plea because he she was previously released on bail on own recognizance,
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 such psychiatric examination be conducted on an outpatient basis, and at such time and place as the State Commissioner of Mental Health shall designate, and it is further
ORDERED that such psychiatric examination shall be completed within 30 days after the defendant has first reported to the place designated by the State Commissioner of Mental Health unless the court, upon application of the said Commissioner, subsequently extends such period in the manner prescribed by law, 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:
________
________
________
________
Name, Address and Telephone Number of 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:
[contact Director of Forensic Services, telephone 518: 474-7275]
Notice to the above-named Defendant:
This Examination Order requires you to submit to a psychiatric examination on an outpatient basis.
You will be notified of the place where such examination will be conducted.
When you are so notified, you must appear at such place on the date and at the time specified in such notice.
Failure to comply with this Examination Order constitutes a contempt of court which may result in the imposition of penal sanctions.
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. II, Forms (cf. Part 110), form B