Fill and Sign the Order of Commitment Not Guilty by Reason of Mental Form

CR-206 , 02/17 Order of Commitment for Treatment (Incompetency) §971.14(5), W isconsin Statutes This form shall not be modified. It may be supplemented with additional mater ial. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of W isconsin, Plaintiff, -vs - , Defendant Name Order of Commitment for Treatment (Incompetency) Date of Birth Case No. Defendant’s: Telephone Number Address Present Location THE COURT FINDS: 1. The defendant was charged and a probable cause determination was made as to the following crime(s): found guilty of the following crime(s): Crime(s) (include enhancers, if any) Wis. Statute(s) Violated Date(s) Committed 2. The defendant is incompetent to proceed at this time, but if provided with appropriate medic ation and treatment, is likely to become competent:  within 12 months, or  the maximum sentence specified for the most serious offense, whichever is less. 3. Involuntary administration of medication A. The involuntary administration of medication(s) and treatment is needed because the 1) defendant poses a current risk of harm to self or others if not medicated or treated. 2) administration of medication and treatment is in the defendant’s medical interest, and 3) defendant is not competent to refuse medication or treatment due to mental illness, developm ental disability, alcoholism, or drug dependence because: The defendant is incapable of expressing an understanding of the advantages and disadvantages of accepting medication or treatment and the alternatives. The defendant is substantially incapable of applying an understanding of the advanta ges, disadvantages and alternatives to his or her mental illness, developmental disability, and alcoholism or drug dependence in order to make an informed choice as to whether to accept or refuse medication or treatment. OR B. The defendant is mentally ill and is charged with at least one serious crime. The i nvoluntary administration of medication(s) or treatment is 1) necessary to significantly further important government interests, and 2) substantially likely to render the defendant competent to stand trial, and 3) substantially unlikely to have side effects that undermine the fairness of the trial by i nterfering significantly with the defendant’s ability to assist counsel in conducting a t rial defense, and Order of Commitment for Treatment (Incompetency) Page 2 of 2 Case No. CR-206 , 02/17 Order of Commitment for Treatment (Incompetency) §971.14(5), W isconsin Statutes This form shall not be modified. It may be supplemented with additional mater ial. Page 2 of 2 4) necessary because alternative, less intrusive treatments are unlikely to achieve substanti ally the same results, and 5) medically appropriate, that is, in the defendant’s best medical interests in light of the defen dant’s medical condition. TH E COURT ORDERS: 1. These proceedings are suspended. 2. The defendant is committed on [Date] to the Department of Health Services (DHS) for  an indeterminate term not to exceed 12 months, or  the maximum sentence specified for the most serious offense, whichever is less. 3. The defendant is granted days of credit for pre-commitment incarceration 4. DHS shall designate the receiving mental health institute. 5. The sheriff shall transport the defendant to and from the designated institute. 6. The institute shall periodically re-examine the defendant and furnish written reports to th e court 3 months, 6 months and 9 months after commitment and 30 days prior to the expiration of the commitment. 7. If box #3 under the findings on Page 1 is checked, DHS is authorized to adminis ter medication(s) or treatment to the defendant and shall observe appropriate medical standards in doing so. 8. The clerk shall provide DHS a copy of the most recent criminal complaint and examiner’s rep ort(s). The examiner shall have access to the defendant’s past and or present records as defined under §51.30( 1)(b), Wis. Stats. 9. Other: BY THE COURT: DISTRIBUTION: 1. Court 2. Sheriff 3. Department of Health Services 4. District Attorney 5. Defendant/Attorney Circuit Court Judge Title (Print or Type Name if not eSigned) 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