VIRGINIA: IN THE CIRCUIT COURT OF LOUDOUN COUNTY COMMONWEALTH OF VIRGINIA v. ) ) ) ) ) CRIMINAL NO. __________ Defendant Conviction Offense ORDER NOTIFYING MENTAL HEALTH PROFESSIONALS OF NEED FOR A MENTAL HEALTH EVALUATION IT IS THIS DATE ORDERED THAT: A mental health evaluation of the defendant be performed by the Loudoun County Department of Mental Health pursuant to the provisions of § __________________ of the Code of Virginia. The report of the said evaluation shall be returnable to the Court at the following date and time: _________________________. The defendant shall promptly attend all meetings scheduled by the Loudoun County Department of Mental Health incident to the preparation of the report. In accord with the provisions of § 19.2-299 of the Code of Virginia, the Office of Probation and Parole shall timely forward a copy of the Presentence Report to the Loudoun County Department of Mental Health Forensic Court Services Program or the agency qualified and ordered to perform the evaluation. The agents of the Loudoun County Department of Mental Health or such other agency ordered to perform the evaluation shall at all times keep the Presentence Report confidential; and, such Presentence Report shall be sealed and returned to the Office of Probation and Parole upon completion of the mental health evaluation. The defendant, by endorsement, represents the following information to be true and correct: American LegalNet, Inc. www.USCourtForms.com Order Respecting the Preparation Of A Mental Health Examination Name: ___________________________________ Address: _________________________________ Telephone No.: ____________________________ Social Security No.: ________________________ Bond Status: ______________________________ THIS ORDER SUPPLEMENTS ANY OTHER ORDERS OF THE COURT RELEVANT TO THE ABOVE-STYLED CASE AND A COPY OF THIS ORDER SHALL BE FORWARDED FORTHWITH BY THE CLERK TO THE LOUDOUN COUNTY DEPARTMENT OF MENTAL HEALTH FORENSIC COURT SERVICES PROGRAM AND TO THE OFFICE OF PROBATION AND PAROLE. ENTERED this ____day of _________, 200_. Judge ___________________________ Defendant American LegalNet, Inc. www.USCourtForms.com