Fill and Sign the Petition for Examination or Assessment Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Petition for Examination or Assessment       Date of Birth Case No.       I request that: 1. The court order a(n): physical examination mental examination psychological examination alcohol or other drug assessment developmental examination of the child/juvenile. parent(s):       guardian:       legal custodian:       2. This examination/assessment should be outpatient inpatient (chapter 938 only) and should be conducted by: a physician:       a psychiatrist:       a licensed psychologist:       another expert (with a master’s degree in social work or another related field of child development):       an approved treatment facility for alcohol and other drug abuse:       3. This examination/assessment should evaluate the following: physical condition mental condition mental competency to proceed developmental condition psychological status ability of the parents to care for the child/juvenile alcohol or other drug abuse dependency whether the juvenile at the time of commission of the alleged delinquent act was not responsible by reason of mental disease or defect the appropriateness of medication, including psychotropic medications other:       4. This evaluation should be done because:       5. The expenses of this examination be paid by: the parents, guardian or legal custodian:       insurance company of child/juvenile/parents/guardian/legal custodian:       the county. Distribution: 1. Original - Court 2. Child/Juvenile/Attorney 3. Parents Signature of Petitioner       Name Printed or Typed       Date JD-1731, 05/00 Petition for Examination or Assessment §§48.295, 938.295, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 JD-1731 , 05/00 Petition for Examination or Assessment §§48.295, 938.295, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.