Fill and Sign the Mental Disease Defect Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use State of Wisconsin, Plaintiff -vs-       , Defendant Name Order for Placement Initial Subsequent (Not Guilty by Reason of Mental Disease or Defect)       Date of Birth Case No.       Defendant’s: Telephone Number       Address       Present Location       THE COURT FINDS: 1. The defendant was committed to the Department of Health and Family Services (DHFS) on (date)       . A copy of the Order of Commitment is attached. 2. On (date)       , the court determined that conditional release would would not pose a significant risk of bodily harm to the defendant or others, or of serious property damage. 3. The involuntary administration of psychotropic medications is needed because: a. The defendant poses a current risk of harm to self or others if not medicated, b. The administration of medication is in the defendant’s medical interest, and c. The defendant is not competent to refuse psychotropic medication or treatment due to mental illness, developmental disability, alcoholism, or drug dependence, because: the defendant is incapable of expressing an understanding of the advantages and disadvantages of accepting psychotropic medication or treatment and the alternatives. OR the defendant is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her mental illness, developmental disability, alcoholism or drug dependence in order to make an informed choice as to whether to accept or refuse psychotropic medication or treatment. THE COURT ORDERS: 1. The following placement: institutional care. The sheriff shall transport the defendant to the mental health institute designated by DHFS. conditional release, subject to the plan approved by the court, which is attached to this order. The defendant shall report immediately to the office of the Department of Corrections, Division of Community Corrections, located in the city of       . 2. DHFS is authorized to administer psychotropic medication or treatment to the defendant and shall observe appropriate medical standards in doing so. CR-275 , 03/04 Order for Placement (Not Guilty by Reason of Mental Disease or Defect) §971.17(3)(c), (d), (e), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Order for Placement (Not Guilty by Reason of Mental Disease or Defect) Page 2 of 2 Case No. Distribution: 1. Court – Original 2. District Attorney 3. Defense Attorney 4. Department of Health and Family Services 5. Department of Corrections 6. §51.42 Board (of county of defendant's residence) 7. Sheriff (where defendant will reside) 8. Municipal Police Department (where defendant will reside) BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date CR-275 , 03/04 Order for Placement (Not Guilty by Reason of Mental Disease or Defect) §971.17(3)(c), (d), (e), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2