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Include the following notice if a minor is named in the caption or if the order contains other unredacted sensitive data. See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Order on Motion for [Physical/Mental] Examination
On [date] the Court considered the Motion for [Physical/Mental] Examination of [name of movant] and ORDERS:
[Name and address of physician, psychologist, or psychiatrist] is appointed to interview, examine, evaluate, and consult with [names] to [detail time, place, manner, conditions, and scope of examination concerning, e.g., mental health of parties, physical condition, blood analysis]. All the above-named persons shall cooperate with this [physician/psychologist/psychiatrist] and attend all appointments and interviews. The initial appointment shall take place on [date] at [time] at [location]. A detailed written report of the examination by the [physician/psychologist/psychiatrist] setting out the [physician/psychologist/psychiatrist]’s findings, including results of all tests made, diagnoses, and conclusions, together with like reports of all earlier examinations of the same condition shall be prepared by [name of physician, psychologist, or psychiatrist] and provided to all parties through their respective attorneys of record on or before [date].
The cost of [name of physician, psychologist, or psychiatrist]’s services shall be borne in the following manner: [specify manner of payment].
SIGNED on ________________________________.
JUDGE PRESIDING
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Forms 5-85 through 5-90 are reserved. |