San Mateo — Order Appointing Doctor(s) for an Examination of the Defendant (Misdemeanor)

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/cr-169.pdf

SUPERIOR COURT OF SAN MATEO COUNTY FOR COURT USE ONLY Southern Branch Northern Branch 400 County Center, 4 th Floor, 1050 Mission Road, Redwood City, CA 94063 South San Francisco, CA 94080 www.sanmateo.courts.ca.gov

PLAINTIFF/APPELLANT: THE PEOPLE OF THE STATE OF CALIFORNIA VS

DEFENDANT/RESPONDENT: CASE NUMBER:

Department No:

ORDER APPOINTING DOCTOR(S) FOR AN EXAMINATION OF THE DEFENDANT Report Due: [Penal Code §§ 1367, 1367.1, 1368, 1368.1, 1370.01]

The Court Orders the following type of Examination:

WHEREAS, it appearing that good and sufficient cause exists for the appointment of doctor(s) to examine the

defendant and investigate his/her competency pursuant to the provisions of PC §§ 1367, 1367.1, 1368, 1368.1, and further to advise the court concerning the issue of voluntary or involuntary administration of antipsychotic medication pursuant to the provisions of PC §§ 1369(b)(1) and 1370.01(a)(2)(B)(ii) to (iii).

WHEREAS, defendant named-above is In custody Out of custody;

THEREFORE, IT IS HEREBY ORDERED THAT:

1. (hereinafter “Examiner”) is appointed to review the information available, including but not limited to any and all medical, mental health, and substance abuse records, examine the defendant and investigate his/her present ability to understand the nature and purpose of the proceedings taken against her and to assist counsel in the conduct of his/her defense in a rational manner. The report submitted to the court shall include: 1) a diagnosis of the defendant’s mental condition, if any; 2) whether the defendant, as a result of a mental disorder or developmental disability, is able to understand the nature of the criminal proceedings or to assist counsel in the conduct of a defense in a rational manner; 3) whether there is a substantial likelihood that the defendant will attain competency in the foreseeable future, with consideration as to whether the defendant would attain competency in response to treatment with antipsychotic medication; and 4) if box 6 below is checked, whether defendant is eligible for mental health diversion pursuant to Section 1001.36.

2. Pursuant to Penal Code section 1367, et seq, the mental health records maintained by Behavioral Health and

Recovery Services, Correctional Health Services and/or the state hospital shall be made available for review and a copy will be provided to the examiner(s) upon request. These records shall include but are not limited to assessments (including diagnosis), treatment plans, discharge summaries, and records documenting mental and physical health conditions as well as treatment provided. Copies of released records will also be made available to the District Attorney and Defense Counsel of record upon their request; and

3. The examiner shall be transported to the defendant’s cell in the event the defendant refuses or is otherwise unable to leave their cell to participate in the evaluation.

4. The examiner(s) appointed will report their opinions and conclusions in writing to this court and will, when summoned, testify in proceedings in which the defendant’s competency may be in question. Examiner’s report is

   ORDER APPOINTING DOCTORS FOR EXAMINATION OF DEFENDANT

CR-169 (Mandatory) [Rev. 07/25] [Penal Code §§ 1367, 1367.1, 1368, 1368.1, 1370.01]

to be submitted to this court on or before the above referenced date. Reports shall be submitted by the examiner(s) to the Court by sending it electronically in PDF format to the Court’s e-mail box DoctorEval@sanmateocourt.org to be received no later than the due date stated herein. If the due date is on a Monday or a date immediately after a holiday, examiner(s) shall make every effort to submit the report prior to the Monday or holiday.

5. The examiner(s) shall contact the ordering Judicial Officer immediately in writing if there is a problem with scheduling an appointment for an evaluation or if the defendant is not cooperating and whose action is obstructing the doctor from complying with this Order. The written communication shall also be sent to the same e-mail address as stated in paragraph 4 above with the name of the judicial officer in the subject line.

6. The Court finds that the defendant is not statutorily precluded from consideration for mental health diversion and hereby orders the examiner to determine whether or not the defendant meets the eligibility criteria set forth in PC 1001.36(b).

7. Pursuant to 11 CCR section 703(b), the court orders the release of State Summary Criminal History Information for the subject of this evaluation to the court-appointed examiner for use in completing this evaluation. The court finds that the release is necessary to allow the examiner to fulfill the statutory obligation to investigate the nature of the defendant’s mental disorder and prior treatment therefor, and to provide an opinion on whether the defendant is a danger to others such that involuntary treatment with antipsychotic medication is indicated under Penal Code section 1370.

8. Defendant requires an interpreter for the evaluation for language. (enter name of language needed)

9. Other special terms: .

Dated:

Judge of Superior Court

Attachment

Distribution: Original: Case File Copies: District Attorney’s Office Defendant’s Attorney of Record

ORDER APPOINTING DOCTORS FOR EXAMINATION OF DEFENDANT

CR-169 (Mandatory) [Rev. 07/25] [Penal Code §§ 1367, 1367.1, 1368, 1368.1, 1370.01]

CASE NUMBER(S):

ADDENDUM – CONTACT INFORMATION FOR THE

ORDER APPOINTING DOCTOR(S) FOR PC § 1367/68 EXAMINATION [THIS PAGE FOR EXAMINER’S USE ONLY – This is not part of the Order]

Defendant: Last Name First Name Middle DOB

Address: (where out-of-custody Defendant can be contacted)

Phone(s): (home, work, cell, parent or spouse or a phone where a message may be left)

I believe it is unlikely that the defendant will be able to keep an appointment to be examined.

Yes No

Reason for PC § 1367: I will call the examiner directly to provide this information.

Ordering Judge: Dept:

Deputy Clerk: Phone Number:

ATTORNEYS OF RECORD:

DEFENSE ATTORNEY: Name: Phone: Email:

DEPUTY DISTRICT ATTORNEY: Name: Phone: Email:

INSTRUCTIONS for Person Submitting ORDER to Examiner(s):

Please complete and email to the examiner

along with the ORDER, the Police Report and the complaint

CONTACT INFORMATION ADDENDUM FOR ORDER APPOINTING DOCTOR(S) ** THIS PAGE FOR EXAMINER’S USE ONLY AND IS NOT PART OF THE ORDER ORDER APPOINTING DOCTORS FOR EXAMINATION OF DEFENDANT

CR-169 (Mandatory) [Rev. 07/25] [Penal Code §§ 1367, 1367.1, 1368, 1368.1, 1370.01]