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Medical Examiner-Mental Health Expert Payment Voucher RI-AD003 - California
| Medical Examiner-Mental Health Expert Payment Voucher Form. This is a California form and can be used in Miscellaneous Riverside Local County . |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE MEDICAL EXAMINER/MENTAL HEALTH EXPERT PAYMENT VOUCHER INSTRUCTIONS The following instructions pertain to requests for payment of medical examiner and interpreter fees on court ordered medical examinations. Section A. General Information: &RPSOHWH WKH IROORZLQJ LQIRUPDWLRQ D E F G 7KH QDPH DGGUHVV HPDLO DQG SKRQH QXPEHU RI WKH FODLPDQWYHQGRU 7KH FDVH QXPEHU LQFOXGLQJ WKH FDVH SUHIL[ 7KH GHIHQGDQW GDWH RI ELUWK 7KH GHIHQGDQW QDPH Section B. Medical Examiners/Mental Health Expert &RPSOHWH WKH IROORZLQJ LQIRUPDWLRQ D E F G H 7KH GDWH RI DSSRLQWPHQW WKH QDPH RI WKH MXGLFLDO RIILFHU ZKR KDV PDGH WKH DSSRLQWPHQW DQG WKH MXGLFLDO RIILFHU¶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he absence of required documents and/or incomplete information may result in a delay in payment. Section C. /Interpreter/Other Services: &RPSOHWH WKH IROORZLQJ LQIRUPDWLRQ D E F G H 6SHFLI\ WKH W\SH RI VHUYLFH SURYLGHG 7KH GDWH RI DSSRLQWPHQW WKH QDPH RI WKH MXGLFLDO RIILFHU ZKR KDV PDGH WKH DSSRLQWPHQW DQG WKH MXGLFLDO RIILFHU¶V GHSDUWPHQW 6SHFLI\ WKH SXUSRVH RI WKH DSSRLQWPHQW DQG WKH DSSOLFDEOH FRGH VHFWLRQ DXWKRUL]LQJ WKH DSSRLQWPHQW 7KH DXWKRUL]HG FRXUW DSSURYHG IHH IRU WKH H[DPLQDWLRQ RUGHUHG DQG FRQGXFWHG &KHFN WKH ER[HV DV WR VXSSRUWLQJ GRFXPHQWDWLRQ DQG DWWDFK WKH GRFXPHQWV DV LQGLFDWHG $ FRS\ RI WKH FRXUW RUGHUV DXWKRUL]LQJ VHUYLFHV DQG D ELOOLQJ LQYRLFH IRU UHTXHVWHG IHHV PXVW EH DWWDFKHG The absence of required documents and/or incomplete information will result in a delay in payment. Section D. Verification: 6LJQ DQG GDWH WKH SD\PHQW YRXFKHU 0DLO WKH FRPSOHWHG SD\PHQW YRXFKHU DQG DOO VXSSRUWLQJ GRFXPHQWV WR WKH &RXUW ZKR RUGHUHG WKH UHSRUW 1RWH 3OHDVH LQFOXGH WKH FDVH QXPEHU RQ DOO LQTXLULHV DQG RWKHU FRUUHVSRQGHQFH Page 1 of 2 $GRSWHG IRU 0DQGDWRU\ 8VH 5LYHUVLGH 6XSHULRU &RXUW 5,$',1)2 >5HY @ MEDICAL EXAMINER/MENTAL HEALTH EXPERT PAYMENT VOUCHER INSTRUCTIONS ULYHUVLGHFRXUWVFDJRYORFDOIUPVORFDOIUPVVKWPO American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE MEDICAL EXAMINER/MENTAL HEALTH EXPERT PAYMENT VOUCHER RI-AD003 SECTION A. GENERAL INFORMATION Medical Examiner/Mental Health Expert Information 1DPH $GGUHVV 3KRQH 1XPEHU (PDLO $GGUHVV &LW\6WDWH=LS &DVH 1R 'HIHQGDQW SECTION B. MEDICAL EXAMINER/MENTAL HEALTH EXPERT 'HIHQGDQW '2% $SSRLQWHG RQ '$7( $SSRLQWHG IRU 'DWH RI ([DP7HVWLPRQ\ $SSRLQWHG E\ -8',&,$/ 2)),&(5 &RGH VHFWLRQ &RXUW $SSURYHG )HH 'HSDUWPHQW 2WKHU _ 1RWLFH RI $SSRLQWPHQW DWWDFKHG _ ,QYRLFH DWWDFKHG 6HUYLFH SURYLGHG $SSRLQWHG RQ '$7( _ 0LQXWH 2UGHU DWWDFKHG _ FRSLHV FRPSOHWHG UHSRUW DWWDFKHG (not applicable for EC 1017 evaluations) SECTION C. INTERPRETER/OTHER SERVICES ,QWHUSUHWHU 2WKHU 63(&,)< 'HSDUWPHQW $SSRLQWHG E\ -8',&,$/ 2)),&(5 $SSRLQWHG IRU 'DWH RI ([DP7HVWLPRQ\ &RGH VHFWLRQ &RXUW $SSURYHG )HH _ 0LQXWH 2UGHU DWWDFKHG SECTION D: 2WKHU _ ,QYRLFH DWWDFKHG , '(&/$5( 7+( )25(*2,1* $1' $1< $77$&+0(176 +(5(72 72 %( $1 $&&85$7( 67$7(0(17 2) 6(59,&(6 5(1'(5(' ,1 7+,6 &$6( 6,*1$785( 2) &/$,0$17 '$7( For Court Use Only )XQG &RVW &HQWHU 3(&7)XQFWLRQDO $UHD */ $SSURYHUV ,QLWLDOV $SSURYHUV 3ULQWHG 1DPH &200(176 'DWH Page 2 of 2 $GRSWHG IRU 0DQGDWRU\ 8VH 5LYHUVLGH 6XSHULRU &RXUW 5,$' >5HY @ MEDICAL EXAMINER/MENTAL HEALTH EXPERT PAYMENT VOUCHER ULYHUVLGHFRXUWVFDJRYORFDOIUPVORFDOIUPVVKWPO American LegalNet, Inc. www.FormsWorkFlow.com
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