FORM SUMMARY Name of Form: Order for Competency Examination by DHFS Form Number: CR-205 Statutory Reference: §§971.14, Wisconsin Statutes Benchbook Reference: CR 12 Purpose of Form: To order forensic examination of defendant in criminal case by Department of Health Services (DHS) to determine if defendant is competent to proceed and assist counsel. Who Completes It: Circuit Court Judge or Court Commissioner Distribution of Form: Original to court file, copies to district attorney, defendant/counsel, examiner/examining facility, and sheriff. Accompanying Forms: None. New Form/Modification: Modification; last update 06/02. Modifications: Changed Department of Health and Family Services to Department of Health Services (DHS). Comments: DHS is funding the competency evaluation program. In the event a person is unable to be examined on an outpatient basis, DHS will continue conducting inpatient examinations at the mental health institutions on a limited basis. This change will shift the focus from DHS routinely conducting exams on an inpatient basis to routinely conducting exams on an outpatient basis. This process will expedite the cases for persons who are incompetent to proceed, and it will also significantly reduce the transport costs to the counties. Each county should develop a procedure to effectuate this change. Questions regarding DHS examinations should be directed to Linda Harris at (608) 267-7909 or Lynne Adolphson at (608) 267-7705. About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 04/24/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Order for Competency Examination by Department of Health Services State of Wisconsin, Plaintiff, -vs- , Defendant Name Case No. Date of Birth Defendant’s: Telephone Number Address Present Location THE COURT FINDS: 1a. The defendant has been charged with the following crime(s), and probable cause has been found. 1b. The defendant has been found guilty of the following crimes, but not yet sentenced. Crime(s) (Attach copy of Complaint and Information for examiner.) Wis. Statute(s) Violated Date(s) Committed 2. There is reason to doubt the defendant’s competency to proceed. Additional information or concerns, if any: THE COURT ORDERS: 1. The defendant shall submit to an examination of his or her competency to proceed. 2. The examination shall be conducted by the Department of Health Services (DHS), which shall determine where the examination will be conducted, who will conduct the examination and whether the examination will be conducted on an outpatient or inpatient basis. Outpatient examination shall be conducted in a jail or a locked unit of a facility unless the defendant is not in custody. 3. If an inpatient examination is necessary, unless the defendant is not in custody, the sheriff shall: • Arrange for the transportation of the defendant to the examining facility within 48 hours after notification. • Return the defendant to the jail within 48 hours, after receiving notice from the examining facility that the examination has been completed. 4. The examiner shall have access to the defendant’s past or present records, as defined under §51.30(1)(b), Wisconsin Statutes. CR-205, 04/08 Order for Competency Examination by DHS §971.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Order for Competency Examination by DHS Page 2 of 2 Case No. 5. The examination shall be completed and a report filed within: • 15 days from the date of this order for an inpatient examination. • 30 days from the date of this order for an outpatient examination. 6. The report shall include a determination on the defendant’s competency to proceed pursuant to §971.14(3), Wisconsin Statutes and the competency of the defendant to refuse medication. 7. A hearing will be held on (date) , before court official , at (time) , or such other time as set by the court. 8. Other: BY THE COURT: Distribution: 1. Court – Original 2. District Attorney 3. Defendant/counsel 4. Examiner/facility 5. Sheriff (if an inpatient exam) Circuit Court Judge/Circuit Court Commissioner Name Printed or Typed Date Name of District Attorney Phone Number Name of Defense Attorney Fax Number Phone Number Fax Number Address of Defense Attorney Address of District Attorney CR-205, 04/08 Order for Competency Examination DHS §971.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com