JD-1731, 08/07 Petition 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 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Petition for Examination or Assessment Case No. I REQUEST : 1. The court order a(n): physical examination mental examination psychological examination alcohol or other drug assessment developmental examination other: of the child/juvenile. parent(s): guardian: legal custodian: 2. This examination/assessment should be outpatient inpatient (chapter 938 only) and should be conducted by: a physician: a psychiatrist: a licensed psychologist: an approved treatment facility for alcohol and other drug abuse: 3. This examination/assessment should evaluate the following: physical condition mental condition mental competency to proceed devel opmental condition psychological status ability of the parents to care for the child/juvenile alcohol or other drug abuse dependency whether the juvenile at the time of commission of the alleged delinquent act was not responsible by reason of mental disease or defect the appropriateness of medication, including psychotropic medications O ther: 4. This evaluation should be done because: 5. The expenses of this examination be paid by the parents, guardian or legal custodian: insurance company of child/juvenile/parents/guardian/legal custodian: the county. the state. DISTRIB UTION: 1. Court 2. Child/Juvenile/Attorney 3. Parents Petitioner Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com