Report Evaluation Form
Competence to Stand Trial
New Mexico
Evaluator's Name
*
Defendant's Name
*
Rater
Date of competency report
*
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Month
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Day
Year
Coverage of Report Elements
Coverage of report
*
Rows
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The overall report quality:
Reason for referral:
Documentation of secure communication:
Documentation informing the defendant about the purpose/nature of the evaluation:
Documentation of information sources:
Report of behavioral observations and mental status:
Relevant history (educational, employment, mental health, legal):
Dx impression, efficacy of prior tx, recommendations:
Rational and factual understanding of the legal proceedings:
Ability to rationally consult with defense counsel:
Capacity to assist in own defense and comprehend the reasons for punishment:
Likelihood of restorability and necessary treatment (if indicated):
Commitment criteria (if indicated)
Assisted outpatient treatment criteria (if indicated):
If testing was used rate appropriateness.
Feedback details
Date of report review:
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Month
-
Day
Year
Date
Calculation
Calculation
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Should be Empty: