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Fill and Sign the Jd 1731 Petition for Examination or Assessment Wisconsin Form

Fill and Sign the Jd 1731 Petition for Examination or Assessment Wisconsin Form

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JD -1 73 1, 0 8/0 7 P etit io n f o r E xa m in atio n o r A sse ssm ent §§4 8.2 95 , 9 38.2 9 5, W is co nsin S ta tu te s. T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 1 o f 1 S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY IN T H E IN TE R EST O F N am e P etit io n f o r E xam in atio n o r A ssessm en t D ate o f B ir th C ase N o. For O ff ic ia l U se I r e quest th at: 1 . The c o urt o rd er a (n ): ph ys ic a l e xa m in atio n m enta l e xa m in atio n psyc h o lo g ic a l e xa m in atio n alc o h ol o r o th er d ru g a sse ssm ent deve lo pm enta l e xa m in atio n o th er: of th e ch ild /ju ve nile . pare nt( s ): guard ia n : le g al c u sto dia n: 2 . This e xa m in atio n/a sse ssm ent s h o uld b e outp atie nt in patie nt ( c h apte r 9 38 o n ly ) a nd s h ou ld b e c o nducte d b y: a p h ys ic ia n: a p syc h ia tr is t: a lic e nse d p syc h o lo gis t: anoth er e xp ert ( w it h a m aste r’s d egre e in s o cia l w ork o r a noth er r e la te d f ie ld o f c h ild d eve lo pm ent) : an a ppro ve d tr e atm ent f a cil it y f o r a lc o ho l a nd o th er d ru g a b use : 3 . This e xa m in atio n/a sse ssm ent s h o uld e va lu ate th e f o llo w in g: ph ys ic a l c o ndit io n m enta l c o nd it io n m enta l c o m pete ncy to p ro ce ed deve lo pm enta l c o ndit io n psyc h o lo g ic a l s ta tu s abilit y o f th e p are nts t o c a re f o r th e c h ild /ju ve nile alc o h ol o r o th er d ru g a b use d ep end ency w heth er th e ju ve nile a t t h e t im e o f c o m mis sio n o f th e a lle g ed d elin q ue nt a ct w as n ot r e sp onsib le b y r e aso n o f m enta l d is e ase o r d efe ct th e a ppro pria te ness o f m edic a tio n, in clu din g p syc h o tr o pic m edic a tio ns oth er: 4 . This e va lu atio n s h ou ld b e d one b eca use : 5 . The e xp ense s o f th is e xa m in atio n b e p aid b y: th e p are nts , g uard ia n o r le g al c u sto dia n: in su ra nce c o m pan y o f c h ild /ju ve n il e /p are nts /g uard ia n /le ga l c u sto d ia n : th e c o u nty . th e s ta te . Sig natu re o f P etit io n er Nam e P rin te d o r T yp ed D is tr ib utio n: 1 . Orig in al - C ourt 2 . Child /J u ve nile /A tt o rn ey 3 . Pare nts Date

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