IN THE SUPERIOR COURT OF THE EASTERN JUDICIAL CIRCUIT STATE OF GEORGIA State of Georgia,
v.
CR
Defendant
ORDER FOR MENTAL EVALUATION RE: COMPETENCY TO STAND TRIAL
WHEREAS the mental competency to stand trial of the above defendant has been
called into question, and the court has found that it Is appropriate for an evaluation to be
conducted at public expense;
IT IS HEREBY ORDERED that the Department of Behavioral Health and
Developmental Disabilities conduct an evaluation of said defendant. provide treatment of
the defendant, if appropriate, and provide to this court a report of diagnosis. prognosis and
its findings, with respect to:
Competency to Stand Trial. Whether the defendant Is capable of understanding
the nature and object of the proceedings; whether the defendant comprehends his or her
own condition in reference to such proceedings; and. whether the defendant is capable of
rendering to counsel assistance in providing a proper defense.
IT IF FURTHER ORDERED that the Department arrange with the county sheriff. or
if the defendant is not in custody. with the defendant's attorney. for the prompt evaluation
of said defendant. either at the county jail. at a deSignated hospital. or at a location agreed
with defense counsel, with transportation of the defendant to be provided by the sheriff.
where necessary. with transportation costs to be borne by the county. Upon completion of
the evaluation. if the defendant is in custody, the evaluating facility shall notify the sheriff,
who shall promptly reassume custody of the defendant. Unless otherwise ordered by the
court the Department shall submit its report to the requesting judge for distribution.
A copy of this Order shall be forwarded to the Department accompanied by a copy
of the indictment, accusation or specification of charges. and where available, a copy of
the police arrest report, and a brief summary of any known or alleged previous mental
health treatment or hospitalization Invotvlng this particular person. Counsel for the
defendant shall forward any other available background information to the evaluator to
assist in performing adequately the requested services.
SO ORDERED this _
day of _ _ _ _ _ 20_.
Penny Haas Freesemann, Judge
Superior Court, E.J.C. of Georgia
cc: aU partin
REFERRAL TO FORENSIC SERVICES Uniform Superior Court Rule 31.4 (A): In pending superior court cases, except in proceedings for
involuntary treatment under OCGA Title 37, or proceedings for the appointment for a guardian under Title
29, where the mental competency of an accused is brought into question, the judge may, upon a proper
showing exercise discretion and require a mental evaluation at public expense. A Motion for mental
evaluation may be filed in writing, setting out allegations and grounds for such motIon, praying for a court­
ordered evaluation. The judge may enter an order requiring a mental evaluation of the defendant for the
purposes of evaluating competency to stand trial. The judge may direct the Department of Behavioral
Health and Developmental Disabilities to perform the evaluation at a time and place to be set by the
Department in cooperation with the county sheriff or counsel for the defendant if the defendant is not in
custody. The clerk shall forward a copy of the order to the Department accompanied by a copy of the
indictment, accusation or specification of charges, and where available, a copy of the police arrest report,
and a brief summary of any known or alleged previous mental health treatment or hospitalization involving
this particular person. Counsel for the defendant shall forward any other background information available
to the evaluator to assist in performing adequately the requested services.
This is a request under Uniform Superior Court Rule 31.4(A), for a mental
evaluation of the following named individual, at public expense.
DATE: _______________
(1) Defendant's Information:
Name: ___________________________________________________
Birthda~:
__________________________________________
Race: ______________
Address:
Gender: ___________
--------------------------------------------------
Contact Phone NumbeB: _____________________________ Relative to Contact: __________________ Relationship: ______ Relative's Address: Relative's Contact NumbeB: _____________________ -------------------------------------------
Current Location (jail, bond, prison, etc) __________________
Any Additional Contact Information: _____________________
(2) WHO INFORMED CLIENT OF IMPENDING EVALUATION? Page 1 of 3
(3) WHAT ARE THE OBSERVATIONS OR CONCERNS THAT HAVE LED TO THIS
COMPETENCY QUESTION BEING RAISED? (Please be specific. Add Addendum
with additional information if necessary. This should includes matters like
previous hospitalizations, unusual behavior in jail or in court, etc. Please tell
what you or your staff have observed):
(4) CURRENT CASE: Current Pending Charges: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Date of Occurrence: ____________________
Next Hearing or Trial Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Trial Judge: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Defense Counsel: Name __________________
Mailing Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Phone:
----------
District Attorney ASSigned: Name: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Mailing Address: _____________________
Phone: __________
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I
(5) PREVIOUS MENTAL HEALTH CARE (Please add whatever information you
may have in this regard. To the extent known, include facility name and dates
treated):
(6) PREVIOUS ARRESTS AND CONVICTIONS, IF KNOWN: (7) DOCUMENTS TO ACCOMPANY COURT ORDER AND REFERRAL FORM
_a.
_b.
_c.
_d.
_e.
Indictment/Accusation related to present charges
Police Report
Any available mental health records
Any available school disciplinary reports, ITBS scores, educational testing
Any available SOCial security disability testing
_f. Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(8) SIGNATURE OF INITIATOR: _ _ _ _ _ _ _ _ _ _ _ __
Print name: _ _ _ _ _ _ _ _ _ __
Phone Number: _ _ _ _ _ _ _ __
NOTE: A Referral for Forensic Services in felony cases shan result in this matter being
placed on the Superior Court's Competency Docket, pending final resolution of the
competency question. In all Superior Court cases, please return the original Referral
Form, supporting documents, and proposed Order to MaryAnn Boyd, Administrative
Assistant for Judge Penny Haas Freesemann, Suite 204, Chatham County Courthouse.
Ms. Boyd can be reached at 912.652.7252 if you have any questions.
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