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

Current through Register Vol. 46, No. 53, December 31, 2024

Form V - Furlough order

FORM V

FURLOUGH ORDER

STATE OF NEW YORK

SUPREME COURT COUNTY COURT

PART: ________ COUNTY: ____________

________

IN THE MATTER

of

A Furlough Order Pursuant to

C PL 330.20 in Relation to

________

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 and now being in the custody of the State Commissioner of Mental Health and confined in a facility for care and treatment pursuant to [check one of the following]

a commitment order issued under the provisions of subdivision 6 of C PL 330.20

a recommitment order issued under the provisions of subdivision 14 of C PL 330.20

a first retention order issued under the provisions of subdivision 8 of C PL 330.20

a second retention order issued under the provisions of subdivision 9 of C PL 330.20

a subsequent retention order issued under the provisions of subdivision 9 of C PL 330.20

by the following court on the following date:

[Name of court] ____________

[Date of order] ____________

And, an application having been made pursuant to subdivision 10 of C PL 330.20 by the State Commissioner of Mental Health for a furlough order;

And, a demand for a hearing not having been made;

And, a demand for a hearing having been made by the District Attorney, and such hearing having been held on ____________;

And, the court, on its own motion, having conducted a hearing on ____________

____________;

And, due deliberation thereon having been had,

And, the court having found that the issuance of a furlough order is consistent with the public safety and welfare of the community and the above-named defendant, and that the clinical condition of the above-named defendant warrants a granting of the privileges authorized by a furlough order,

It is hereby

ORDERED that the Commissioner of Mental Health is directed to allow the above-named defendant, now in confinement in a facility pursuant to the aforesaid order, to temporarily leave the facility for [here insert a period of time not exceeding 14 days] ________ under the following terms and conditions:

(a) While outside the facility pursuant to this order, the above-named defendant shall be under the constant supervision of one employee two employees three employees of the facility;

(b) While outside the facility pursuant to this order, the above-named defendant need not be under the constant supervision of any employee of the facility;

(c) [Here insert any terms and conditions that the court deems necessary or appropriate]

____________

____________

Dated: ________

____________

Justice of the Supreme Court

Judge of the County Court

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