ORDER OF REFERRAL FOR EVALUATION Page 1 of 2 March 2015 IN THE DISTRICT COURT OF THE STATE OF WSHINGTON IN AND FOR THE COUNTY OF CHELAN STATE OF WASHINGTON ) ) NO. Plaintiff, ) ) ORDER OF REFERRAL vs. ) FOR EVALUATION ) ) , ) Defendant. ) ) THIS matter coming on before the above-entitled court on defendant's Petition for Deferred Prosecution, and the court having examined the petition filed by the defendant and the affidavit attached thereto, finds that the defendant is charged with a gross misdemeanor crime of Driving While Intoxicated which may be the result of or caused by an alcohol problem for which the defendant is in need of treatment; that, unless the problem is treated, the probability of future reoccurrence of the alleged crime is great, and the defendant has agreed to pay the costs of diagnosis and evaluation. NOW, THEREFORE, said defendant is hereby referred to located at in , WASHINGTON, an approved treatment agency, for an evaluation and diagnosis of defendant's alcohol problem to determine, after a thorough investigation and examination, if: 1. The defendant suffers from the problem mentioned herein; 2. If the problem is not treated whether there is a probability that similar misconduct will occur in the future; 3. Whether extensive and long-term treatment is required and would be effective if instituted; and 4. Whether effective treatment is available and what that treatment would include. American LegalNet, Inc. www.FormsWorkFlow.com ORDER OF REFERRAL FOR EVALUATION Page 1 of 2 March 2015 The approved treatment agency shall report, in writing, to the court its findings and recommendations; and if treatment is recommended it shall set out a treatment plan showing: (a) The type of treatment; (b) The nature of the treatment; (c) The length of said treatment; (d) A treatment time schedule; and (e) The approximate cost of said treatment plan. Said report shall be filed with this court for its consideration on or before the day of , 20, A copy of said report shall be furnished to the defendant's attorney and to the prosecuting attorney. DATED this day of , 20. DISTRICT COURT JUDGE Presented by: WSBA Attorney for Defendant American LegalNet, Inc. www.FormsWorkFlow.com