22 CRR-NY D VI Form 16-bNY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 22. JUDICIARY
SUBTITLE D. FORMS
CHAPTER VI. FORMS FOR USE IN COURTS EXERCISING CRIMINAL JURISDICTION
22 CRR-NY D VI Form 16-b
22 CRR-NY D VI Form 16-b
16-b Examination report
C.P.L. Article 730 FORM 16-b 12/88
EXAMINATION REPORT (Psychiatric Examination)
_________
COURT OF
_________
COUNTY OF
_________
__________
x
 
EXAMINATION REPORT
PEOPLE OF THE STATE OF NEW YORK,
 
Docket No.
__
– against –
 
Indictment No. __ _______, Defendant. __________x
I, the undersigned. duly certified pursuant to law as a (qualified psychiatrist) (certified psychologist), having been designated by __, Director of __, pursuant to an order signed by Hon. __, (Judge) (Justice) of the __ Court, __ County, dated __, to examine the above-named defendant, pursuant to Article 730 of the Criminal Procedure Law, to determine if the defendant is an incapacitated defendant, have conducted such examination with due care and diligence.
The nature and extent of the examination was as follows:
 
 
 
I have come to the following opinion as a result of such examination:
(NOTE TO EXAMINER): If the following paragraph sets forth the opinion of the examiner, sign the report where indicated below and do not complete page 2. Otherwise, strike out the following paragraph, complete fully the remainder of this report and sign on page 2.)
It is my opinion that the above-named defendant does not as a result of mental disease or defect lack capacity to understand the proceedings against him or her or to assist in his or her own defense.
Dated:
______
 
Signature
Printed Name
It is my opinion that the above-named defendant is an incapacitated person in that as a result of mental disease or defect, (he) (she) lacks capacity to understand the proceeding against (him) (her) to assist in (his) (her) own defense. My opinion is based on the following:
(1) History and clinical summary, including mental status.
 
(Attach additional sheets, if necessary):
 
(2) Diagnosis:
(3) Prognosis:
(4) Reasons for my opinion, specifying those aspects of the proceedings wherein the defendant lacks capacity to understand or to assist in (his) (her) own defense: (Attach additional sheets, if necessary):
Dated:
______
 
Signature
Printed Name
22 CRR-NY D VI Form 16-b
Current through May 31, 2021
End of Document