CR-275, 08/12 Order for Placement (Not Guilty by Reason of Mental Disease or Defect) 247971.17(3)(c), (d), (e), 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 Placement Initial Subsequent (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 [Date] . A copy of the Order of Commitment is attached. 2. On [Date] , the court determined that conditional release would would not pose a significant risk of bodily harm to the defendant or others, or of serious property damage. 3. The involuntary administration of psychotropic medications is needed because the A. defendant poses a current risk of harm to self or others if not medicated; B. administration of C. defendant is not competent to refuse psychotropic medication or treatment due to mental illness, developmental disability, alcoholism, or drug dependence, because the defendant is incapable of expressing an understanding of the advantages and disadvantages of accepting psychotropic medication or treatment and the alternatives. OR substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her mental illness, developmental disability, alcoholism or drug dependence in orde r to make an informed choice as to whether to accept or refuse psychotropic medication or treatment. THE COURT ORDERS: 1. The following placement is institutional care. The sheriff shall transport the defendant to the mental health institute designated by DHS. co nditional release, subject to the plan approved by the court, which is attached to this order. The defendant shall report immediately to the office of the Department of Corrections, Division of Community Corrections, located in the city of . 2. DHS is authorized to administer psychotropic medication or treatment to the defendant and shall observe appropriate medical standards in doing so. THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL . DISTRIBUTION: 1. Court 2. District Attorney 3. Defense Attorney 4. Department of Health Services 5. Department of Corrections 6. 24751.42 Board (of county of defendant's residence) 7. Sheriff (where defendant will reside) 8. Municipal Police Department (where defendant will reside) American LegalNet, Inc. www.FormsWorkFlow.com