OCR Program

Outpatient Competency Restoration (OCR)/Outpatient Competency Attainment (OCA) Program
Acknowledgment*

I confirm that I have all the required documents ready to submit with this form, as per the instructions, to ensure the processing of my referral request. (If some of the documents are unavailable to you, please note below in additional comments box.)
Date*

MonthDayYear
Today's Date
Last Name of Defendant to Receive OCR/OCA Services*
First Name of Defendant to Receive OCR/OCA Services*
OCR/OCA Defendant’s Date of Birth*

MonthDayYear
Date
OCR/OCA Defendant’s Preferred Gender*
Referring Court or Agency*
Who is ordering OCR/OCA take place? (e.g., Judge, Magistrate, or other Individual name)*
Who should we contact if we have questions about this referral?*

First NameLast Name
Referral Source Contact Email Address*
example@example.com
Referral Source Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Personal Address (Please include their personal address even if they are in a facility.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the defendant residing in a facility at this time?*

YesNo
Name of Facility/Institution
Defendant's Personal Phone Number*
Entering a valid phone number is REQUIRED, even if they are in a facility.Format: (000) 000-0000.
Name and phone number or email address of family member, legal guardian, or other person to contact defendant, if applicable.
Defense Attorney Name (If none, type "N/A" in both boxes.)*

First NameLast Name
Defense Attorney Email Address*
example@example.com
Defense Attorney Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Prosecuting Attorney Name*

First NameLast Name
Prosecuting Attorney Email Address*
example@example.com
Prosecuting Attorney Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please note the ACTUAL hearing date pertaining to OCR/OCA. (ONLY answer if a hearing date has been scheduled. If none scheduled, note as TBD.)*
Docket/Case No.(s)*
Is there anything else you would like us to know about this referral? (e.g., You can add names and contact information for collateral sources or other colleagues, anything not mentioned above that you would like us to know, etc.)
Who will we send progress reports to? (e.g., judge/magistrate, you as referral contact, probation, etc.)*
Is this a correction to a referral already filed?*

YesNo
Please upload the required documents. For security reasons, please DO NOT EMAIL documents to individual CDTC staff members. If need be, we can also send you a shared folder link for transfer or accept/pick up recording materials.*

Cancelof
Certification:*

I certify that all information I provide on the referral form is accurate to the best of my knowledge
Should be Empty:

Outpatient Competency Restoration (OCR)/Outpatient Competency Attainment (OCA) Program