Examination For Alcohol Or Drug Dependence Motion And Order Form. This is a Connecticut form and can be use in Criminal Statewide.
Tags: Examination For Alcohol Or Drug Dependence Motion And Order, JD-CR-91, Connecticut Statewide, Criminal
EXAMINATION FOR ALCOHOL OR DRUG DEPENDENCE MOTION AND ORDER STATE OF CONNECTICUT SUPERIOR COURT JD-CR-91 Rev. 9-12 C.G.S. § 17a-693, 17a-694, 17a-695, 17a-696, 17a-699 Instructions To Defendant - Fill out this form and give it and 2 copies of it to the Clerk of Court and give another copy to the Prosecuting attorney(s). To Clerk - If motion is granted, immediately distribute copies of this form and the defendant's Consent for Release of Information as follows: (1) Send to CSSD - copy of this form and copy of consent. (2) Send to DMHAS treatment facility - copy of this form and original signed consent. (3) Retain original of this form and copy of consent in court file. Next court date Docket number TO: The Superior Court of the State of Connecticut Judicial District or Geographic area Address of court Motion (To Be Completed by the Defendant or State's Attorney) Name of defendant Defendant's telephone Sex Date of birth Race Address of defendant Name and address of defendant's attorney Crime(s) charged/convicted of (Include date offense committed) If incarcerated, location being held at (name and address of facility) Released Incarcerated I, the Defendant ask for an order of the court that the defendant be examined pursuant to Section State's Attorney 17a-694 of the General Statutes to determine if the defendant is dependent on drugs or alcohol. I make the following statements: Defendant charged but has not had a trial yet Defendant convicted but not yet sentenced Is not charged with 1. The defendant Seeks waiver of ineligibility because of being 1. The defendant was not convicted of murder, charged with attempt to commit murder, kidnapping, operating under the influence, a violation of Section 14-227a or assault in the robbery in the first degree or any felony second degree with a motor vehicle in violation of Section 53a-60d of the involving serious physical injury. General Statutes or with a class A, B or C felony. 2. The defendant has not been previously 2. The defendant Was not twice previously ordered treated ordered treated under Sections 19a-387 or Seeks waiver of ineligibility because the 21a-285 of the General Statutes, revised to defendant was twice previously ordered treated 1989 or Section 17a-699. under the provisions of Section 17a-696, subsection (i) of Section 17-155y, Section 19a-386 or Section 21a-284 of the General Statutes, revised to 1989, or any combination thereof. I ask that the court order that the defendant be examined for alcohol or drug dependence in accordance with Section 17a-694. Date signed Order Signed (Defendant) Consented to by (Parent or Guardian) Appointment Of Examiner(s) I have read the above, I understand it and I agree with it. Signed (Attorney for Defendant) Signed (State's Attorney) The foregoing motion is denied. Having found that the interests of justice will be served, the foregoing motion is granted subject to the defendant executing the attached Consent for Release of Information. By the court (Print or type name of Judge) Signed (Judge or Assistant Clerk) Date signed TO: The Clinical Examiner You are ordered to examine the above-named defendant and submit a signed written report of your findings and deliver it to the court, the Court Support Services Division, the state's attorney and the defendant's attorney within thirty days of the Date of Order shown below. The examiner will not be required to be present to testify on the report unless the examiner receives a separate notice from the court, the state's attorney or the defendant's attorney requesting the examiner's presence to testify. In its report, the examiner shall indicate whether the defendant was an alcohol-dependent or drug-dependent person at the time of the crime(s). If the defendant is determined to have been dependent on alcohol or drugs, the examiner is to further determine (1) the history and pattern of the dependency, and (2) whether the defendant presently needs and is likely to benefit from treatment for the dependency. If the examiner determines that the defendant presently needs and is likely to benefit from treatment, the examiner shall recommend treatment, including provisions for the appropriate placement and the type and length of treatment, which may include provisions for outpatient treatment, and state the date space will be available in an appropriate treatment program, provided such date shall not be more than forty-five days from the date of the examination report. Date of Order By the court (Print or type name of Judge) Signed (Assistant Clerk) Date signed Notice To Defendant - Nothing that you say during this examination, if the judge orders it, may be used to show that you are guilty in your criminal case. American LegalNet, Inc. www.FormsWorkFlow.com