Canada Province of Nova Scotia

Canada Province of Nova Scotia

INTHE COURT

HerMajestytheQueen v.

NSForm51/48

NSYForm119

Revised08/14

Order#

(NameandI.D.numberofaccused/youngperson)

ASSESSMENTORDER

(Sections672.13C.C. and 141YCJA)

Approved:

Judge

D/M/Y

BEFORE______:

(name)

WHEREASIhavereasonablegroundstobelievethatevidenceofthementalconditionof

of

(nameof accused/youngperson)(address)

whohasbeenchargedwiththefollowingoffence(s):

CaseNo(s).andBriefDescriptionofOffence(s) Section DateofOffence(s) Place

maybenecessarytodetermine:*

□whether theaccused/youngpersonisunfitto standtrial

□whethertheaccused/youngpersonsufferedfromamentaldisordersoastoexempttheaccused/youngpersonfromcriminal responsibilitybyvirtueofsubsection16(1)oftheCriminalCodeatthetimeoftheactoromissionchargedagainsttheaccused/young person

□whethertheaccused/youngperson isadangerous mentallydisorderedaccused/youngpersonundersection672.65oftheCriminal

Code

□whetherthebalanceofthemindoftheaccused/youngpersonwasdisturbedatthetimeofcommissionoftheallegedoffence(s),where

theaccused/youngpersonisafemalepersonchargedwithanoffencearisingoutofthedeathof hernewly-bornchild

□whereaverdictofunfittostandtrialoraverdictofnotcriminallyresponsibleonaccountofmentaldisorderhasbeenrenderedinrespect oftheaccused/youngperson,theappropriatedispositiontobemadeinrespectoftheaccused/youngpersonpursuanttosection672.54 or 672.58oftheCriminalCode

IORDERanassessmentofthementalconditionoftheaccused/youngpersonbeconducted

□by

□attheEastCoastForensicPsychiatricHospital.(Adult)

□attheIsaakWaltonKillamHospital.(Youth)

□AttachedasScheduleAisabriefstatementofmyreasonsformakingthisorder.

Thisorder istobein forceuntil anduntilthentheaccused/young personis tobe* (date)

□outofcustody,onthefollowingconditions:

□incustodyata □HospitaldesignatedbytheMinisterofHealthforNovaScotiapursuanttos.672.1C.C.

□ProvincialCorrectionInstitution

□YouthCustodyFacility

IORDERthata writtenassessmentreportbefiledwiththeCourtClerkat ,NovaScotia,nolaterthan

,20 .

DATEDat ,NovaScotia,on ,20 .

*Checkapplicableoption.

Distribution:Court

Accused/YoungPerson

Prosecutor DefenseCounsel Hospital/Institution/Facility

□ EastCoast Forensic Psychiatric Hospital, Fax 460-7343

□YouthForensicService

Judge,JusticeofthePeace