New Mexico Competency Rating Form 4.0
Defendant name
First Name
Last Name
Evaluator Name
First Name
Last Name
Date of Evaluation
-
Month
-
Day
Year
Date
Date of Report
-
Month
-
Day
Year
Date
Rater
Date Rated
-
Month
-
Day
Year
Date
Identifying information/referral
Rows
Fully Described
Partially Described
Omitted
Reason for referral
Alleged offense(s)
Site of evaluation
Telehealth security
Dates included
Custody status noted
Identifying information/referral calculation
Notice of confidentiality/consent/assent
Rows
Yes
No
Explained nature and purpose of evaluation
Explained who may receive the report
Explained limits of confidentiality / non-treatment role
Explained right not to answer questions
Explained possibility of testimony
Defendant appeared to understand advisement (with data point).
Confidentiality/assent score calculation
History
Rows
Relevant data cited or refused
Tangential data added
Not addressed
Family/social/living situation
Relationship history
Educational history
Employment history
Medical history
Mental health history
Substance use history
Legal involvement history
Prior competency findings/restoration
Treatment participation/adherence
History score calculation
Data Sources
Rows
Yes
Partially
No
Are alll data sources cited together?
If psychological tests are used, are all properly listed?
If used, are all collaterals identified?
If prior data are used, are all properly noted?
Data source calculation
Psychological Testing
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
If testing was warranted, were appropriate tests used?
Were tests results described in normative context?
Were test results explained with implications of competency?
Were any deficiencies noted?
Psychological testing score calculation
Behavioral Observations / Current Functioning / Mental Status Examination
Rows
Discussed with supporting data points
Mentioned
Not discussed
Alertness
Orientation
Attention/concentration
Memory
Speech/Language
Thought form
Thought Content
Perception/psychotic symptoms
Mood/Affect
Insight
Judgment
Behavioral regulation
MSE calculation
Diagnosis and Clinical Formulation
Rows
Not Satisfied
Somewhat Satisfied
FullySatisfied
Diagnoses based on observed data
Diagnoses by history
Treatment participation / compliance history
Clinical formulation focused on functional impact
Diagnostic score calculation
Rational and Factual Understanding of Legal Proceedings
Rows
Not Satisfied
Somewhat Satisfied
FullyDemonstrated
Understands current charge(s)
Understands seriousness / possible penalties
Understands plea options
Understands role of judge
Understands role of defense counsel
Understands role of prosecutor
Understands role of jury
Understands witnesses / evidence
Understands courtroom process
Rational understanding of own case
Understanding of proceedings
Ability to Rationally Consult with Defense Counsel
Rows
Not Satisfied
Somewhat Satisfied
Fully Demonstrated
Can communicate relevant facts
Can disclose helpful / harmful information
Can follow attorney advice
Can weigh legal options
Can maintain working alliance
Can participate in decision-making
Can manage courtroom behavior with counsel support
Can manage courtroom behavior with counsel support
Consultation with counsel
Capacity to Assist in Own Defense and Comprehend Reasons for Punishment
Rows
Fully addressed
Partially Addressed
Not Addressed
Understands allegations against self
Can identify possible defenses or disputes
Can track evidence relevant to defense
Appreciates likely outcomes of decisions
Appreciates reasons punishment may occur
Can behave in self-protective legal manner
Assist in defense/comprehend reasons for punishment
Reliability/Validity flags (check one)
Rows
Yes
No
Validity and reliability noted as adequate
If no, is rationale provided for recommendation
Reliability/validity flag
Opinion Regarding Competence to Stand Trial and Related Matters
Rows
Clear statement present
Somewhat Satisfied
No statement?
Does not apply
Clear comptency recommendation
If incompetent, statement on commitment
If incompetent, statement on restoration
If incompetent, statement on assisted outpatient treatment
Opinion score
Writing Quality
Rows
Very good to excellent
Acceptable
Many Issues
Avoiding typographical errors
Grammar/punctuation errors
Cohesion/style/clarity
Writing Score
Total score
Comments by reviewer
Submit
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