The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

 

 

 

 

 

 

 

 

 

COURT DIVISION 

MENTAL HEALTH DOCKET NO. (if any) 

MASSACHUSETTS TRIAL COURT 

   

CRIMINAL DOCKET NO. (if any) 

Petition for 30 Day Examination 
and Observation Pursuant to 
G.L. c. 123, § 18(a) 

IN THE MATTER OF 

PETITIONER 

DOB 

TITLE 

GENDER 

SSN 

 Male 

 Female 

FACILITY 

The Petitioner respectfully represents that the he/she is a physician or psychologist qualified 
by the Department of Mental Health to perform psychiatric examinations of prisoners. The Petitioner 
has examined the Respondent, a prisoner at said institution, pursuant to a request made by: 

person in charge of place of detention 

title 

name of place of detention 

 

 

A report on the mental condition of said prisoner is attached.  The prisoner is currently: 

  a pretrial defendant charged with   

(This petition to be filed in court of criminal jurisdiction.) 

list charges and docket numbers 

OR 

  serving sentence which expires on   

(This petition to be filed in court with jurisdiction over place of detention.) 

date sentence expires 

I believe the prisoner should be committed to  
not to exceed 30 days for observation, for the following reasons: 

facility 

, for a period 

 

   

   

 

   

   

   

   

Therefore, I request the Court order such commitment. 

Date 

Signature 

Print Name 

Title 

(Rev. 1.26.17) 

Please attach report from place of detention.

Petition for 30 Day Examination and Observation Pursuant to G.L. c. 123

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Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 1
Fields(s): 27
Average fields per page: 27
Reading Level: Grade 11
LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

crimina_l_docke_n was CRIMINAL DOCKET NO if any (0.65 conf)
menta_l_healt_h_docke_n was MENTAL HEALTH DOCKET NO if any (0.45 conf)
n_th_e_matte_r was IN THE MATTER OF (0.45 conf)
users1_birthdate was DOB (1.00 conf)
ssn was SSN (0.34 conf)
cour_division was COURT DIVISION (0.41 conf)
petitioners1_name was PETITIONER (1.00 conf)
title__1 was TITLE (0.27 conf)
facility__1 was FACILITY (0.33 conf)
institution_pursuant_made was has examined the Respondent a prisoner at said institution pursuant to a request made by (0.43 conf)
title__2 was title (0.27 conf)
name_place_detention was name of place of detention (0.39 conf)
report_mental_prisoner was A report on the mental condition of said prisoner is attached The prisoner is currently (0.33 conf)
pretrial_defendant_charged was a pretrial defendant charged with (0.44 conf)
exceed_observation_reasons__1 was not to exceed 30 days for observation for the following reasons 1 (0.33 conf)
exceed_observation_reasons__2 was not to exceed 30 days for observation for the following reasons 2 (0.33 conf)
exceed_observation_reasons__3 was not to exceed 30 days for observation for the following reasons 3 (0.33 conf)
signature_date was Date (1.00 conf)
users1_signature was Signature (1.00 conf)
print_name was Print Name (0.42 conf)
title__3 was Title (0.27 conf)
date_sentence_expires was date sentence expires (0.32 conf)
facility__2 was facility (0.33 conf)
check_box__1 was Check Box5 (0.37 conf)
check_box__2 was Check Box6 (0.37 conf)
check_box__3 was Check Box8 (0.37 conf)
check_box__4 was Check Box9 (0.37 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition for 30 Day Examination and Observation Pursuant to G.L. c. 123

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02