Insanity Defense Evaluation Form
Use this form to record a structured evaluation of case facts, behavioral observations, and supporting notes for an insanity defense review.
Case Identification
Case Name or Reference Label
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Name or Role
*
Behavioral and Mental State Assessment
Behavioral and Mental State Ratings
*
Rows
Low
Moderate
High
Awareness of reality
1
2
3
Ability to distinguish right from wrong
4
5
6
Coherence of reasoning
7
8
9
Recall of the incident
10
11
12
Current orientation
13
14
15
Brief observations
Relevant Incident Factors
Did the incident involve any of the following factors?
*
Intoxication
Medication effects
Sleep deprivation
None of the above
Describe the incident context and any observed contributing factors
*
Prior History and Supporting Information
Documented prior history of similar episodes?
*
Yes
No
Unknown
Supporting records, witness statements, or background notes
Final Evaluation Summary
Overall Strength of Insanity Defense Evaluation
*
Very Weak
1
2
3
4
5
6
7
8
9
Very Strong
10
1 is Very Weak, 10 is Very Strong
Final Summary / Recommendation
*
Additional Review Recommended?
Yes
No
Submit
Should be Empty: