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Examination Report To Determine Capacity 3-17 - New York
|Examination Report To Determine Capacity Form. This is a New York form and can be used in Juvenile Delinquency Family Court Statewide .||
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Secs. 301.2, 322.1 F.C.A. Form 3-17 (Juvenile Delinquency) 7/83 In the Matter of Docket No. A Person Alleged to be a Juvenile Delinquent Respondent. EXAMINATION REPORT. (To Determine Capacity) TO THE FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF a duly (qualified psychiatrist) (certified psychologist) hereby reports as follows: 1. I examined , the Respondent herein, pursuant to an order of the Court dated , to determine whether Respondent is (mentally ill) (mentally retarded or developmentally disabled) on (date) at (location) on (date) - at (location) 2. Based upon the above examination(s), in-my professional judgment, (is) (is not) an incapacitated person as defined in subdivision (13) of section 301.2 of the Family Court Act. *3. I base this opinion upon the following a. Diagnosis b. Prognosis *(Note to examiner) If a finding of incapacity is made, you must complete items 3 and 4 of this form. 2002 © American LegalNet, Inc. Form 3-17 page 2 *4. The following is a detailed statement of the reasons for my opinion: [Make particular reference to those aspects of the proceedings wherein Respondent lacks capacity to understand or to assist in defense.] Dated: **(Qualified Psychiatrist) Signature **(Certified Psychologist) *Applicable if report finds Respondent to be an incapacitated person. "Strike out one. 2002 © American LegalNet, Inc.