Forensic Psychiatric Report

Your Name

Address

Phone #

FORENSIC PSYCHIATRIC REPORT

Competence to Stand Trial

Subject’s Name

Case #:

DOB:

Date

REASON FOR REFERRAL:

The purpose of this evaluation is to determine whether _____, a defendant facing charges of _____ is fit to proceed to trial.

I performed this evaluation at the request of _____

OPINION:

It is my opinion, with a reasonable degree of medical certainty, that _____ is fit to proceed.

SOURCES OF INFORMATION:

1. Interview of _____ for _____ hours on _____

2. Criminal complaint and statements

3. Discussion with defense attorney

4.

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:

Education/employment/relevant social and family history

Prior psychiatric evaluation, diagnoses, treatment, hospitalizations

Substance abuse history, if relevant and not prejudicial

Medical history (such as head injury), if relevant

Prior psychological or intellectual testing

Information related to the crime, if relevant

Behavior or observations raising concern about fitness

Mental health since arrest/while incarcerated

Prior fitness evaluations

Current psychotropic medications, if any

MENTAL STATUS EXAMINATION:

General mental status:

Appearance

Behavior

Speech

Flow of thought

Affect

Mood (and suicidality/aggression)

Review of other symptoms (sleep, appetite, energy, anxiety, etc.)

Hallucinations

Delusions

Orientation, memory, concentration, abstract thought

Factual knowledge:

Charges

Potential maximum sentence

Roles of court personnel:

Defense attorney

Prosecutor/district attorney

Judge

Jury

Witnesses

Court procedures:

Plea options

Potential outcomes

Plea bargain

Time-served

Insanity defense

Testimony, right to remain silent

Objections (sustained/overruled)

Observations relevant to ability to weigh options and make reasoned decisions about his case

Observations relevant to ability to work with his attorney in his defense

DIAGNOSIS:

Axis I:

Axis II:

Axis III:

FORMULATION:

The legal question is whether _____ has a factual and rational understanding of the charges against him and can assist his attorney in his defense.

Respectfully submitted,

Your name

Licensed Psychiatrist

Board-certified in Psychiatry, ABPN

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