Order For Mental Health Evaluation
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Order For Mental Health Evaluation Form. This is a Maryland form and can be use in Circuit Court Statewide.
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Tags: Order For Mental Health Evaluation, CM-11, Maryland Statewide, Circuit Court
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Defendant
FOR
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v.
CIRCUIT COURT
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Plaintiff
IN
THE
Civil No.:
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ORDER FOR MENTAL HEALTH EVALUATION
THE COURT HAVING DETERMINED that a psychological evaluation of a party or
day of
,
by
minor child is necessary, it is this
County, Maryland, hereby
the Circuit Court for
ORDERED that
Name of Mental Health Evaluator
be appointed to conduct a mental health evaluation of the following person(s):
; and it is further
ORDERED that the mental health evaluation shall include the following:
[
]
a clinical assessment of the persons referenced above; and it is further
[
]
a clinical assessment and any psychodiagnostic testing deemed appropriate by
the evaluator; and it is further
ORDERED that the evaluation is to be paid for in the following manner:
; and it is further
ORDERED that upon completion of this evaluation a formal report will be submitted to
the Court for review prior to final disposition of this case.
JUDGE
Recommended by:
(Date)
Page 1 of 2
CM 11 - Revised 9 March 2000
2001 © American LegalNet, Inc.
NOTICE
Communications between the mental health evaluator and the persons ordered to submit
to a mental health evaluation are not confidential and shall not be privileged. All
meetings with the mental health evaluator shall be considered conducted for the purposes
of litigation and may be referred to or disclosed at trial or in documents prepared in
conjunction with the pending court action.
cc:
Mental Health Evaluator
Address
City
State
Zip
Page 2 of 2
CM 11 - Revised 9 March 2000
2001 © American LegalNet, Inc.
