mental health
FORENSIC MENTAL HEALTH ASSESSMENT
REPORT TO THE CIRCUIT COURT
Chapter 916, Part II, Florida Statutes
I.
IDENTIFYING INFORMATION:
Defendant: Full Name
Sex:
Marital Status:
DOB:
Race and Ethnicity:
Case Number(s):
Related Charges:
II.
REFFERAL AND SERVICE INFORMATION:
The evaluator should name the State Attorney/designee, Defense Attorney/designee, or Judge who referred the case. For example, "John Q. Public, Assistant State Attorney referred this case on June· xx, 2030." The judge in a case may be the only cited source of referral when initial communications involving the case excluded the assigned attorneys at the time of referral. Also include here a recitation of the referral question and discussion of notices regarding the nature and purpose of evaluation, absence of confidentiality, and any applicable privilege, as well as the examinee's understanding of this notice.
Current Evaluator: Name, degree, title (optional if using letterhead with the same information
Date(s) of Evaluation:
.
Date of Report: Month, Day, Year
General Finding(s): recommended disposition (e.g. Competent to Proceed, Incompetent to
Proceed, Insanity Opinion)
Ill.
SOURCES OF INFORMATION:
Provide in this section a listing of all sources of information considered or reviewed (e.g., interview
(note how much time was devoted to an interview); psychological testing; review of arrest reports or other third party documents such as depositions, medical records, criminal justice records, or school records; interview with others such as family members, arresting officers, jail staff, treating health care professionals).
IV.
RELEVANT HISTORY:
The historical section is a compilation of narrative information describing past events indicative of an individual's psychosocial functioning across time. The evaluator must apply clinical judgment when considering the relevance and accuracy of all sources of information, including the defendant's
REPORT TO THE CIRCUIT COURT
Chapter 916, Part II, Florida Statutes
I.
IDENTIFYING INFORMATION:
Defendant: Full Name
Sex:
Marital Status:
DOB:
Race and Ethnicity:
Case Number(s):
Related Charges:
II.
REFFERAL AND SERVICE INFORMATION:
The evaluator should name the State Attorney/designee, Defense Attorney/designee, or Judge who referred the case. For example, "John Q. Public, Assistant State Attorney referred this case on June· xx, 2030." The judge in a case may be the only cited source of referral when initial communications involving the case excluded the assigned attorneys at the time of referral. Also include here a recitation of the referral question and discussion of notices regarding the nature and purpose of evaluation, absence of confidentiality, and any applicable privilege, as well as the examinee's understanding of this notice.
Current Evaluator: Name, degree, title (optional if using letterhead with the same information
Date(s) of Evaluation:
.
Date of Report: Month, Day, Year
General Finding(s): recommended disposition (e.g. Competent to Proceed, Incompetent to
Proceed, Insanity Opinion)
Ill.
SOURCES OF INFORMATION:
Provide in this section a listing of all sources of information considered or reviewed (e.g., interview
(note how much time was devoted to an interview); psychological testing; review of arrest reports or other third party documents such as depositions, medical records, criminal justice records, or school records; interview with others such as family members, arresting officers, jail staff, treating health care professionals).
IV.
RELEVANT HISTORY:
The historical section is a compilation of narrative information describing past events indicative of an individual's psychosocial functioning across time. The evaluator must apply clinical judgment when considering the relevance and accuracy of all sources of information, including the defendant's