Court Referral – Forensic Evaluation Service Center

FESC Referral Information for Evaluation

For Courts and Agencies Referring Cases to FESC

County Referring *

Referring Source *

This is the PRIMARY contact and court or entity responsible for this case.

Who should we contact if we have questions about this referral? *

First

Last

Email of person to contact if we have questions *

Name@countyProbation.org

Who is ordering the evaluation? *

Choose Judge, magistrate, or it could be another group.

Defendant's (or youth or Alleged Incompetent) Name *

First

Last

Defendant's Date of Birth: mm/dd/yyyy *

Docket #(s)

Please list the docket number we can use to look up the case(s) on the Clerk of Courts website for the corresponding county.

Present Charge(s) *

Name(s), # of counts, F# or M# (for ex. F-2) and if you can, the ORC #.

Date of the offense (mm/dd/yyyy)

You can only put one of the dates in here, if there are other dates, just put those in the comments. The date of the offense helps us get more accurate information.

POST CONVICTION or Other - Pursuant to Ohio Revised Code Section: *Check All that Apply

2947.06/2967.22 MITIGATION of Penalty/Post Sentence - Probation or Parole
Local Rule: JUVENILE PSYCH EVALUATION
Local Rule: JUVENILE RISK ASSESSMENT
2950.09 (B)(2)) CLASSIFICATION OF SEXUAL PREDATOR
OTHER: leave notes in comments

Choose ALL the legal questions listed on the court order.

OTHER QUESTIONS/ORDERS

2111.031 GUARDIANSHIP Person/Estate
OUTPATIENT COMPETENCY RESTORATION (OCR)
RISK OF VIOLENCE/DANGEROUSNESS
Other Competency to Waive Miranda, Pro Se, be a Witness, or Consent
Civil Commitment Evaluation
Domestic Relations Court
OTHER: leave notes in comments

Additional Comments about the referral: (anything you might want us to know)

The ACTUAL COURT DATE - Answer only there is an ACTUAL date

If less than 30 days, please call and discuss the timing allowance. We will let you know if we need more time than is allotted and ask for a continuance.

The court needs this report by (mm/dd/yyyy) *

We will provide reports to the court at least one business day ahead of court, unless other arrangements have been made.

Where is the defendant? Choose one *

In our county jail
In a different county jail from the referring county
Out in the community

If he/she is not incarcerated YOU MUST GIVE US A PHONE NUMBER to find this defendant.

PHONE contact for defendant or family member or other person to contact defendant

If this defendant gets out of your jail - we will need to track them down. PLEASE GIVE US A PHONE NUMBER.

Who will we send this report to? *

The judge's last name here is fine.

Phone # for court personnel in case we need more information

Defense Attorney Name (or none) *

First

Last

If none - type NONE in both boxes.

Defense Attorney Email

for ex. name@site.org

Defense Attorney Phone

for ex. 5138694014

Prosecuting Attorney Name (or contact for prosecutor's office)

First

Last

if none - type none in both boxes.

Prosecuting Attorney Email

for ex. name@site.org

Prosecuting Attorney Phone

for ex. 5138694014

Comment here with anything else that you want us to know.

You can add names and contact info for collateral sources or other colleagues, for instance.

IS this a CORRECTION to a referral already filed?

PLEASE UPLOAD up to 3 documents via this link. Audio/Video are probably too big for this method of transfer

Click or drag files to this area to upload. You can upload up to 3 files.

We can send you a shared folder link for transfer or accept/pick up recording materials. We can take up to 3 files through here, and you can submit more via the short form below or email or fax 513-867-5868

I have attached files to this referral

YES - see attached
No, I will email them to forensicservices@fesc-oh.org
No, I will contact you at 513-869-2010 to make arrangements.

Comment