Fill and Sign the Order for Competency Examination Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use State of Wisconsin, Plaintiff, -vs-       , Defendant Name Order for Competency Examination by DHFS       Date of Birth Case No.       Defendant’s: Telephone Number       Address       Present Location       THE COURT FINDS: 1a. The defendant has been charged with the following crime(s), and probable cause has been found. 1b. The defendant has been found guilty of the following crimes, but not yet sentenced. Crime(s) (Attach copy of Complaint and Information for examiner.)       Wis. Statute(s) Violated       Date(s) Committed       2. There is reason to doubt the defendant’s competency to proceed. Additional information or concerns, if any:       THE COURT ORDERS: 1. The defendant shall submit to an examination of his or her competency to proceed. 2. The examination shall be conducted by the Department of Health and Family Services (DHFS), which shall determine where the examination will be conducted, who will conduct the examination and whether the examination will be conducted on an outpatient or inpatient basis. Outpatient examination shall be conducted in a jail or a locked unit of a facility unless the defendant is not in custody. 3. If an inpatient examination is necessary, unless the defendant is not in custody, the sheriff shall:  Arrange for the transportation of the defendant to the examining facility within 48 hours after notification.  Return the defendant to the jail within 48 hours, after receiving notice from the examining facility that the examination has been completed. 4. The examiner shall have access to the defendant’s past or present records, as defined under §51.30(1)(b), Wisconsin Statutes. CR-205 , 06/02 Order for Competency Examination by DHFS §971.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Order for Competency Examination by DHFS Page 2 of 2 Case No. 5. The examination shall be completed and a report filed within:  15 days from the date of this order for an inpatient examination.  30 days from the date of this order for an outpatient examination. 6. The report shall include a determination on the defendant’s competency to proceed pursuant to §971.14(3), Wisconsin Statutes and the competency of the defendant to refuse medication. 7. A hearing will be held on (date)       , at (time)       , before court official       , or such other time as set by the court. 8. Other:       Distribution: 1. Court – Original 2. District Attorney 3. Defendant/counsel 4. Examiner/facility 5. Sheriff (if an inpatient exam) BY THE COURT: Circuit Court Judge/Circuit Court Commissioner       Name Printed or Typed       Date Name of District Attorney       Name of Defense Attorney       Phone Number       Fax Number       Phone Number       Fax Number       Address of District Attorney       Address of Defense Attorney       CR-205 , 06/02 Order for Competency Examination by DHFS §971.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2