Tip for COE (state-specific)

The evaluation must be conducted by a qualified professional (psychiatrist, psychologist, or licensed clinical social worker depending on jurisdiction)

Tip for COE (state-specific)

The evaluation report is typically confidential and available only to the court and parties

Tip for COE (state-specific)

The evaluated individual has the right to an independent evaluation at their own expense

Behavioral Healthvery hardDoctor signature required

Court-Ordered Evaluation (COE) Form

COE (state-specific) · State Courts

Detailed evaluation of an individual meeting criteria for court-ordered treatment (danger to self, danger to others, persistently/acutely disabled, gravely disabled). Requires two behavioral health professionals.

Form Details

Total fields: 60
Auto-fillable: 22 (37%)
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Filled by: doctor
Frequency: as needed
State-specific: Yes — form may vary by state

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Where to Submit This Form

🏢

File a motion or petition with the court that has jurisdiction

May be filed in civil, criminal, or family court depending on the context. Requirements vary by jurisdiction.

Filing Deadline

Depends on the legal proceeding. In criminal cases, competency evaluations may be requested at any time before trial. In civil cases, file when the need becomes apparent.

Required Attachments

📎 Motion or petition for court-ordered mental health evaluation
📎 Supporting affidavit or declaration with specific facts necessitating the evaluation
📎 Any available medical records or prior evaluations
📎 Proposed evaluator qualifications (some courts maintain a list of approved evaluators)
📎 Filing fee (varies by jurisdiction; may be waived for indigent petitioners)

Processing Time

Court ruling on the motion: 1-4 weeks. Completion of the evaluation: 30-60 days after the court order is issued. Reports due to the court per the order's timeline.

What Happens Next

The court will schedule a hearing on the motion. If granted, the court will appoint an evaluator and set a deadline for the report. The evaluator's report is submitted to the court and may be used in subsequent proceedings.

Tips for This Form

✓ The evaluation must be conducted by a qualified professional (psychiatrist, psychologist, or licensed clinical social worker depending on jurisdiction)
✓ The evaluation report is typically confidential and available only to the court and parties
✓ The evaluated individual has the right to an independent evaluation at their own expense
✓ Evaluators must be impartial — the court may reject an evaluation by a treating clinician

More Behavioral Health Forms

Mental Health Parity Disclosure Request

Parity Disclosure (insurer/state-specific) · Health Insurance Plans / State DOI

Request for insurer to disclose how it applies parity requirements: comparing treatment limits, medical necessity criteria, and non-quantitative treatment limitations (NQTLs) between mental health/substance use and medical/surgical benefits.

Mental Health Claim Appeal (with Parity Analysis)

MH Appeal Letter · Member / Attorney

Written appeal documenting how a denial violates the Mental Health Parity and Addiction Equity Act (MHPAEA). Appeals with specific parity violation documentation have significantly higher approval rates.

DOL MHPAEA Complaint Form

EBSA MHPAEA Complaint · U.S. Department of Labor (EBSA)

Complaint to DOL Employee Benefits Security Administration about employer-sponsored plan violations of mental health parity requirements under the MHPAEA.

Substance Abuse Treatment Authorization Request

SUD PA (insurer-specific) · Health Insurance Plans

Prior authorization for inpatient detox, residential treatment, intensive outpatient (IOP), or medication-assisted treatment (MAT). Subject to MHPAEA parity requirements.

42 CFR Part 2 Substance Use Disorder Consent

42 CFR Part 2 Consent · Substance Abuse Treatment Programs

Special consent required under federal law (42 CFR Part 2) for disclosure of substance use disorder treatment records. More restrictive than standard HIPAA authorization. Requires specific elements including prohibition on re-disclosure.

Petition for Involuntary Examination

Baker Act / 5150 / Section 12 (state-specific) · State Courts / Law Enforcement / Providers

Legal petition for involuntary psychiatric examination of a person believed to meet criteria for danger to self/others or grave disability. Known by different names: Baker Act (FL), 5150 (CA), Section 12 (MA), and other state-specific designations.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Courts or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.