For Official Use STATE OF WISCONSIN, CIRCUIT COURT, State of Wisconsin, Plaintiff -vs, Defendant Name COUNTY Order for Examination under §971.17(4)(c) (Not Guilty by Reason of Mental Disease or Defect) Case No. Date of Birth Defendant's: Present Location (Include municipality and county) THE COURT FINDS: 1. The defendant was committed to the Department of Health Services (DHS) on [Date] A copy of the Order of Commitment is attached. 2. A petition for conditional release of the defendant has been filed by the defendant. director of the mental health facility at which the defendant is committed. . THE COURT ORDERS: 1. The defendant be examined by [Name] to determine if the defendant is appropriate for conditional release. 2. The examiner report on the type of treatment and services needed by the defendant while on conditional release in the community if the examiner believes the defendant is appropriate for conditional release. 3. All of the defendant's treatment records requested by the examiner be released to the examiner. 4. The clerk provide the examiner a copy of the most recent criminal complaint and all other examiner's report(s). 5. The report be furnished to the court no later than [Date] 6. A hearing be held on [Date] 7. Other: THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. BY THE COURT: DISTRIBUTION: 1. Court Original 2. District Attorney 3. Defense Attorney 4. Examiner 5. Department of Health Services 6. Mental Health Institute 7. Defendant . at [Time] A.M. P.M.. Circuit Court Judge Clerk of Circuit Court Name Printed or Typed Date CR-277, 08/12 Order for Examination under 971.17(4)(c) (Not Guilty by Reason of Mental Disease or Defect) §971.17(4)(c), Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material.