Form JD-CR-91 "Examination for Alcohol or Drug Dependence - Motion and Order" - Connecticut

What Is Form JD-CR-91?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2015;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-CR-91 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-CR-91 "Examination for Alcohol or Drug Dependence - Motion and Order" - Connecticut

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EXAMINATION FOR ALCOHOL
STATE OF CONNECTICUT
OR DRUG DEPENDENCE -
SUPERIOR COURT
MOTION AND ORDER
JD-CR-91 Rev. 5-15
C.G.S. § 17a-693, 17a-694, 17a-695, 17a-696, 17a-699
Instructions
ADA NOTICE
To Defendant - Fill out this form and give it and 2 copies of it to the Clerk of Court and give
The Judicial Branch of the State of Connecticut complies with
another copy to the Prosecuting attorney(s).
the Americans with Disabilities Act (ADA). If you need a
To Clerk - If motion is granted, immediately distribute copies of this form and the defendant's
reasonable accommodation in accordance with the ADA,
Consent for Release of Information as follows:
contact a court clerk or an ADA contact person listed at www.
(1) Send to CSSD - copy of this form and copy of consent.
jud.ct.gov/ADA.
(2) Send to DMHAS treatment facility - copy of this form and original signed consent.
(3) Keep the original of this form and copy of consent in court file.
Next court date
Docket number
TO: The Superior Court of the State of Connecticut
Judicial District or Geographic area
Address of court
Name of defendant
Sex
Race
Address of defendant
Defendant's telephone
Date of birth
Name and address of defendant's attorney
Crime(s) charged/convicted of (Include date offense committed)
If incarcerated, location being held at (name and address of facility)
Released
Incarcerated
I, the
State's Attorney
Defendant
ask for an order of the court that the defendant be examined pursuant to section
17a-694 of the General Statutes to determine if the defendant is dependent on drugs or alcohol.
I make the following statements:
Defendant charged but has not had a trial yet
Defendant convicted but not yet
sentenced
1. The defendant
Is not charged with
Seeks waiver of ineligibility because of being
1. The defendant was not convicted of murder,
charged with
attempt to commit murder, kidnapping,
a violation of sections 14-227a or 53a-60d of the Connecticut General
robbery in the first degree, or any felony
Statutes, or with a class A, B, or C felony.
involving serious physical injury.
2. The defendant
Was not twice previously ordered treated
2. The defendant has not been previously
Seeks waiver of ineligibility because the
ordered treated under sections 17a-699 or
defendant was twice previously ordered treated
19a-387 of the Connecticut General Statutes
under sections 17a-696, 17-155y (i), or 19a-386 of the Connecticut
or section 21a-285 of the Connecticut General
General Statutes, or under section 21a-284 of the Connecticut General
Statutes, revised to 1989.
Statutes, revised to 1989, or any combination of these sections.
Date signed
I have read the above information.
Signed (Defendant)
I understand it, and I agree with it.
Consented to by (Parent or Guardian)
Signed (Attorney for Defendant)
Signed (State's Attorney)
The foregoing motion is denied.
Having found that the interests of justice will be served, the foregoing motion is granted, subject to the defendant executing the
attached Consent for Release of Information.
By the court (Print or type name of Judge)
Date signed
Signed (Judge or Assistant Clerk)
TO: The Clinical Examiner
You are ordered to examine the above-named defendant, prepare a signed written report of your findings, and deliver it to the court,
the Court Support Services Division, the state's attorney and the defendant's attorney within thirty days of the Date of Order shown
below. You will not be required to be present to testify on the report unless you receive a separate notice from the court, the state's
attorney or the defendant's attorney requesting your presence to testify.
In your report, you shall indicate whether the defendant was an alcohol-dependent or drug-dependent person at the time of the
crime(s). If you determine that the defendant was dependent on alcohol or drugs, you are further ordered to determine (1) the history
and pattern of the dependency, and (2) whether the defendant presently needs and is likely to benefit from treatment for the
dependency. If you determine that the defendant presently needs and is likely to benefit from treatment, you shall recommend
treatment, including provisions for the appropriate placement and the type and length of treatment, which may include provisions for
outpatient treatment, and state the date that space will be available in an appropriate treatment program, provided such date shall not
be more than forty-five days from the date of the examination report.
Date of Order
By the court (Print or type name of Judge)
Date signed
Signed (Assistant Clerk)
Nothing that you say during this examination, if the judge orders it, may be used to
Notice To Defendant -
show that you are guilty in your criminal case.
Print Form
Reset Form
EXAMINATION FOR ALCOHOL
STATE OF CONNECTICUT
OR DRUG DEPENDENCE -
SUPERIOR COURT
MOTION AND ORDER
JD-CR-91 Rev. 5-15
C.G.S. § 17a-693, 17a-694, 17a-695, 17a-696, 17a-699
Instructions
ADA NOTICE
To Defendant - Fill out this form and give it and 2 copies of it to the Clerk of Court and give
The Judicial Branch of the State of Connecticut complies with
another copy to the Prosecuting attorney(s).
the Americans with Disabilities Act (ADA). If you need a
To Clerk - If motion is granted, immediately distribute copies of this form and the defendant's
reasonable accommodation in accordance with the ADA,
Consent for Release of Information as follows:
contact a court clerk or an ADA contact person listed at www.
(1) Send to CSSD - copy of this form and copy of consent.
jud.ct.gov/ADA.
(2) Send to DMHAS treatment facility - copy of this form and original signed consent.
(3) Keep the original of this form and copy of consent in court file.
Next court date
Docket number
TO: The Superior Court of the State of Connecticut
Judicial District or Geographic area
Address of court
Name of defendant
Sex
Race
Address of defendant
Defendant's telephone
Date of birth
Name and address of defendant's attorney
Crime(s) charged/convicted of (Include date offense committed)
If incarcerated, location being held at (name and address of facility)
Released
Incarcerated
I, the
State's Attorney
Defendant
ask for an order of the court that the defendant be examined pursuant to section
17a-694 of the General Statutes to determine if the defendant is dependent on drugs or alcohol.
I make the following statements:
Defendant charged but has not had a trial yet
Defendant convicted but not yet
sentenced
1. The defendant
Is not charged with
Seeks waiver of ineligibility because of being
1. The defendant was not convicted of murder,
charged with
attempt to commit murder, kidnapping,
a violation of sections 14-227a or 53a-60d of the Connecticut General
robbery in the first degree, or any felony
Statutes, or with a class A, B, or C felony.
involving serious physical injury.
2. The defendant
Was not twice previously ordered treated
2. The defendant has not been previously
Seeks waiver of ineligibility because the
ordered treated under sections 17a-699 or
defendant was twice previously ordered treated
19a-387 of the Connecticut General Statutes
under sections 17a-696, 17-155y (i), or 19a-386 of the Connecticut
or section 21a-285 of the Connecticut General
General Statutes, or under section 21a-284 of the Connecticut General
Statutes, revised to 1989.
Statutes, revised to 1989, or any combination of these sections.
Date signed
I have read the above information.
Signed (Defendant)
I understand it, and I agree with it.
Consented to by (Parent or Guardian)
Signed (Attorney for Defendant)
Signed (State's Attorney)
The foregoing motion is denied.
Having found that the interests of justice will be served, the foregoing motion is granted, subject to the defendant executing the
attached Consent for Release of Information.
By the court (Print or type name of Judge)
Date signed
Signed (Judge or Assistant Clerk)
TO: The Clinical Examiner
You are ordered to examine the above-named defendant, prepare a signed written report of your findings, and deliver it to the court,
the Court Support Services Division, the state's attorney and the defendant's attorney within thirty days of the Date of Order shown
below. You will not be required to be present to testify on the report unless you receive a separate notice from the court, the state's
attorney or the defendant's attorney requesting your presence to testify.
In your report, you shall indicate whether the defendant was an alcohol-dependent or drug-dependent person at the time of the
crime(s). If you determine that the defendant was dependent on alcohol or drugs, you are further ordered to determine (1) the history
and pattern of the dependency, and (2) whether the defendant presently needs and is likely to benefit from treatment for the
dependency. If you determine that the defendant presently needs and is likely to benefit from treatment, you shall recommend
treatment, including provisions for the appropriate placement and the type and length of treatment, which may include provisions for
outpatient treatment, and state the date that space will be available in an appropriate treatment program, provided such date shall not
be more than forty-five days from the date of the examination report.
Date of Order
By the court (Print or type name of Judge)
Date signed
Signed (Assistant Clerk)
Nothing that you say during this examination, if the judge orders it, may be used to
Notice To Defendant -
show that you are guilty in your criminal case.
Print Form
Reset Form