JD-1732, 11/15 Order for Examination or Assessment 24724748.295 and 938.295, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order for Examination or Assessment Case No. THE COURT FINDS: 1. Reasonable cause to order an examination or assessment. 2. There is probable cause to believe the juvenile has co mmitted the alleged offense and there is reason to doubt 3. The juvenile entered a plea of not responsible by reason of mental disease or de fect. IT IS ORDERED : 1. The following examination/assessment be conducted physical examination psychological examination developmental examination mental examination alcohol or other drug assessment O ther: of the child/juvenile . parent(s): guardian: legal custodian: 2. This examination/asses sment shall be outpatient inpatient (chapter 938 only) and shall be conducted by a physician: a psychiatrist: a licensed psychologist: another expert ted field of child development) an approved treatment facility for alcohol and other drug abuse: 3. This examination/assessment should evaluate the following : Physical condition . M ental competency to proceed . American LegalNet, Inc. www.FormsWorkFlow.com JD-1732, 11/15 Order for Examination or Assessment 24724748.295 and 938.295, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 P sychological status . A lcohol or other drug abuse dependency . W hether the juvenile at the time of commission of the alleged delinquent act was not responsible by reason of mental disease or defect . M ental condit ion . D evelopmental condition . A bility of the parents to care for the child/juvenile . A ppropriateness of medication, including psychotropic medications . O ther: 4. The costs of th is examination shall be paid by the parents, guardian or legal custodian: insurance company of child/juvenile/parents/guardian/legal custodian: the county. 5. The examiners shall file the following written report with the court: Assessment : Within 14 days from the date of this order. This report shall include a recommendation whether treatment, intervention and/or education is needed, and if so, shall recommend a service plan and appropriate treatment, intervention and/or education. Examination : No later than [ D ate ] . Thi s report must contain a description of the nature of the examination; the persons interviewed, the records reviewed, the tests administered, and the facts and reasoning upon which the opinion is based, as well as: If the examination is ordered because of a reason to doubt the j assist in his or her defense, and if the examiner reports that the juvenile lacks competency to proceed, an opinion regarding the likelihood that the juvenile, if provided treatment, may be restored to competency within the lesser of the following time periods: 12 months. the maximum sentence that may be imposed on an adult for the most serious delinquent act with which the juvenile is charged: If the examination is ordered because of a plea of not responsible by reason of mental diseas e or defect, an opinion whether the juvenile suffered from mental disease or defect at the time of commission of the alleged act, AND if so, whether this caused the juvenile to lack substantial capacity to appreciate the wrongfulness of his or her conduct; or, conform his or her conduct to the requirements of law. Other: NOTICE: If a competency or NGI evaluation is ordered, a reasonable contribution toward the cost of the evaluation(s) may uardian(s), based on their ability to pay. This report is to be sent to the court at: DISTRIBUTION: 1. Court 2. Child/Juvenile/Attorney/GAL 3. Parents/Guardian/Legal Custodian/Attorney 4. Provider conducting examination/assessment 5. Court appointed special advocate, if any 6. District attorney/Corp. Counsel 7. Petitioning Attorney 8. Agency 9. Other: American LegalNet, Inc. www.FormsWorkFlow.com