Your Name
Address
Phone #
FORENSIC PSYCHIATRIC[JH1]REPORT
Testamentary Capacity
Subject’s Name
Case #:
DOB:
Date
REASON FOR REFERRAL:
The purpose of this evaluation is to determine whether _____has [JH2]the capacity to make a will.
I performed this evaluation at the request of _____.
OPINION:
It is my opinion, with a reasonable degree of medical certainty, that _____ has [JH3]the capacity to make a will.
SOURCES OF INFORMATION:
1.Interview [JH4]of _____ for _____hours on _____
2[JH5].
CONFIDENTIALITY:
At the start of the interview, I explained to _____ the purpose of the evaluation, my role, and the limits of confidentiality.
RELEVANT PRIOR HISTORY:
Psychosocial development[JH6]/relationships
Education/IQ
Employment performance
Family history
Psychiatric history (evaluation, testing,diagnoses, treatment, hospitalizations)
Substance abuse history
Prior findings of incompetence/assignment of guardian
Criminal history, if relevant
Medical history
ADAPTIVE FUNCTIONING AT THE TIME OF WILL [JH7]CREATION:
Circumstances of creation of the will
Notable contents [JH8]of the will
Functioning on the job and in managing finances/property/dependants
Nature and extent of relations with family members and significant others
Controlling or coercive involvement of others
Recent evidence of mental status change or illness[JH9]
Evidence of future plans
MENTAL STATUS EXAMINATION[JH10]:
General mental status[JH11]:
Appearance
Behavior
Speech
Flow of thought
Affect
Mood (and suicidality/aggression)
Review of other symptoms (sleep, appetite, energy, anxiety, etc.)
Hallucinations
Delusions[JH12]
Orientation, memory, concentration
Intellect, knowledge, comprehension
Insight, judgment, abstract thought
Adaptive/functional abilities:
Use of money/calculation
Knowledge of assets, bills, benefits, cost of living
Problem solving regarding child care, transportation, shopping, banking
Future plans
Testamentary capacity[JH13]:
Knowledge that a will is being made
Knowledge of the nature and extent of property
Knowledge of the natural objects of his/her bounty[JH14]
Feeling towards/relationship with [JH15]those in the will and other natural objects of his/her bounty
Knowledge of the manner in which the will disposes of the property
Assessment of how the will is likely to impact others
FURTHER STUDIES:
Consider intelligence, psychological, or neuropsychological testing
DIAGNOSIS:
Axis I:
Axis II:
Axis III:
FORMULATION:
Clinical formulation
Does/did the testator know he/she is/was making a will?
Does/did the testator know the natural objects of his/her bounty?
Does/did the testator know the nature and extent of his/her property?
Was the will the product of a delusional belief?
Does the will reflect coercion, compulsion, or restraint [JH16]by another on the testator?
Respectfully submitted,
Your name
Licensed Psychiatrist
Board-certified in Psychiatry[JH17], ABPN
1
[JH1]Or psychological
[JH2]Or had.
Most such evaluations are conducted posthumously.
[JH3]Or lacks.
Or had or lacked.
[JH4]If the testator is deceased, give a disclaimer to that effect here and do not include a MSE section.
[JH5]List all available mental health records as well as interviews with family members or other providers. In cases of posthumous evaluation, interviews of those who had contact with the testator at the time of the creation of the will are particularly important, especially those who are not contesting the will and less biased.
Also list any wills provided to you, and the dates they were written.
[JH6]The following are a suggested list of historical domains to be covered in chronological order, deleting the headings as you fill them in.
[JH7]This section is most critical in the case of a posthumous evaluation. Retitle “Current Adaptive Functioning” if the testator is still alive and has not yet prepared a will, but is planning to do so.
[JH8]Especially changes from one will to another, or unusual conditions or assignment of bounty.
[JH9]Particularly signs of dementia and/or paranoia.
[JH10]This section would be omitted in a posthumous evaluation, unless the testator left a videotape statement to accompany the will.
Note any suspicious (i.e., controlling) involvement of others in the examination.
[JH11]The following domains are suggested areas that should be covered, deleting the headings as you fill them in.
[JH12]Particularly relevant is any “insane delusion” about testator’s relatives or the nature of his property.
[JH13]If the evaluation is posthumous, you will need to look for evidence of these capacities in sources other than an interview.
[JH14]i.e., who would stand to inherit if there were no will.
[JH15]Close and loving, or distant and remote? Paranoid? Hostile? Controlling or influential?
[JH16]Special circumstances which may invalidate a will.
[JH17]Or other relevant title and credentials.