CR-277, 08/12 Order for Examination under 247971.17(4)(c), Wis. Stats. (Not Guilty by Reason of Mental Disease or Defect) 247971.17(4)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Date of Birth Order for Examination under 247 971.17(4)(c), Wis. Stats. (Not Guilty by Reason of Mental Disease or Defect) Case No. Present Location (Include municipality and county) THE COURT FINDS: 1. The defendant was committed to the Department of Health Services (DHS) on [D ate ] . A copy of the Order of Commitment is attached. 2. A Petition for Conditional Release of the defendant has been filed by the defendant. director of the mental health facility at which the defendant is committed. THE COURT ORDERS: 1. The defendant be examined by [N ame ] to determine if the defendant is appropriate for conditional release. 2. The examiner report on the type of treatment and services needed by the defendant while on conditional release in the community if the examiner believes the defendant is appropriate for conditional release. 3. 4. The c 5. The report be furnished to the court no later than [D ate ] . 6. A hearing be held on [D ate ] at [Time] a.m. p.m . 7. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. DISTRIBUTION: 1. Court 2. District Attorney 3. Defense Attorney 4. Examiner 5. Department of Health Services 6. Mental Health Institute 7. Defendant American LegalNet, Inc. www.FormsWorkFlow.com