________________________________ COURT

______________________ County, Arizona

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

Defendant (FIRST, MI, LAST)

The Court having been presented with a motion under Rule 11.2, Rules of Criminal Procedure, for an examination to determine whether the defendant is competent, or to investigate the defendant's mental condition at the time of the offense,

IT IS HEREBY ORDERED appointing _________________________ as a mental expert, to prepare and send to this Court a written report of the expert's opinion and findings as to whether reasonable grounds for a mental health examination exist.

IT IS FURTHER ORDERED that if the defendant is not in custody, defense counsel is to contact the expert at [telephone number] __________ within two (2) working days of this order to schedule a time for the defendant's examination and use due diligence to secure the defendant's attendance at the examination.

IT IS FURTHER ORDERED that the prosecutor and defense counsel provide to the expert at [address] _________________________ the motion to have defendant's mental condition examined, copies of police reports, previous mental health reports and any other appropriate material for the screening examination.

IT IS FURTHER ORDERED that payment of the cost of the examination of the defendant is the responsibility of the __________ pursuant to A.R.S. § 13-4505.

IT IS FURTHER ORDERED that a prescreen hearing will be held in this court on the ___ day of ____________________ 20 ___, at __________ a.m./p.m.

IT IS FURTHER ORDERED that at least _____ days prior to the prescreen hearing date the expert will submit the written report to the Court, which will seal the original and provide a copy to defense counsel. Defense counsel shall provide a redacted copy of the report to the Court and the prosecutor's office within a reasonable time after receipt.

Signature of Judicial Officer

Date

Defense Attorney (please print name)

Prosecutor (please print name)

Telephone No.

Bar No.

Telephone No.

Bar No.

Mailing Address

Mailing Address

City State Zip

City State Zip