Mental Health Treatment Law, 5751-1991

____________ The prosecutor / The appellant*

by (counsel _______ / State Attorney's Office _______ / prosecution unit _______*)

versus

____________ The defendant / The respondent*

by (counsel _______ / State Attorney's Office _______ / prosecution unit _______*)

Hospitalisation Order / Order for Outpatient Treatment*

(pursuant to section 15 of the Mental Health Treatment Law, 5751-1991 (hereinafter – the Law))

To: The district psychiatrist, district ___________

A hospitalisation order / order for outpatient treatment* is hereby issued in respect of the defendant:

_____________ (family name) __________ (given name) __________ (father's name) _____________ (identity number or identification document and its number)

The defendant's address or place of the defendant's lawful custody (including an institution or hospital):

___________ (street name) _____ (number) _________ (name of locality)

________ (postal code)

** who is incapable of standing trial in accordance with the provisions of section 15(a) of the Law, and in respect of whom there is prima facie evidence that the defendant committed the offence act with which the defendant was charged in the indictment or another offence act, all as detailed below:

** who committed the offence act with which the defendant was charged, as detailed below, but who is not criminally liable in accordance with the provisions of section 15(b) of the Law:

The offence/s ______________________________

Section/s of the offence/s _________________________ (the enactment and the number of the section or regulation)

I hereby bring to your attention that in accordance with section 15(d1) of the Law, the maximum period of the Order (hospitalisation, outpatient treatment, or a cumulative period of hospitalisation and outpatient treatment that the psychiatric committee is authorised to order as referred to in section 28(b) of the Law) of the abovementioned shall be **:

The term of imprisonment prescribed in the Law alongside the abovementioned offence, which is ____ years (commencing on _______***);

If the defendant was brought to trial before a Magistrate's Court under section 51(a)(1)(b) of the Courts Law [Consolidated Version], 5744-1984 – seven years (commencing on _______***);

If there were several offences as aforesaid – the longest term of imprisonment among the terms of imprisonment prescribed alongside the abovementioned offences, which is ____ years (commencing on _______***);

In exceptional cases and for special reasons that shall be recorded – a period shorter than the term of imprisonment prescribed in the Law alongside the offence, under section 15(d1)(2a) of the Law, which is ____ years (commencing on _______***);

If the said offence was an offence carrying mandatory life imprisonment – 25 years (commencing on _______***);

Under the Law, the defendant's matter, if the defendant is still hospitalised or receiving outpatient treatment, must be brought before the district psychiatrist at least two weeks before the end of the maximum hospitalisation or treatment period as aforesaid, for the purpose of the district psychiatrist's decision as referred to in section 15a of the Law, and notice must also be given to the Attorney General, the District Attorney and the Israel Police that the said period is about to expire. This Order shall serve as authority for any person authorised to carry out the said hospitalisation / outpatient treatment*.

Delete as appropriate

** Mark as appropriate

*** The commencement of the hospitalisation or outpatient treatment under this Order, or an earlier date if the court has determined in respect of the defendant that periods of hospitalisation under section 16 of the Law are to be counted towards the maximum hospitalisation or treatment period, as referred to in section 15(d1)(3) of the Law.