BOP Program Statement 5070.12 § 21

records and information applicable to this program are available

in the Records and Information Disposition Schedule (RIDS) system

in BOPDOCS and Sallyport. Information created by this program is

also governed by all applicable FOIA/PA laws and regulations.

/s/

Harley G. Lappin

Director

P5070.12

4/16/2008

Attachment A

EXAMPLE

Date (fill in)

The Honorable______________

United States District Court

Western District Of Missouri St. Joseph Division

6672 Charles Evans Whittaker United States Court House

400 East 9 Streetth

Kansas City, Missouri 64106

Re:

Reg. No. __________

Case No. __________

Dear Judge _____:

Your Court Order dated fill in date here committed Mr. X to the custody of the Attorney

General for a mental health evaluation pursuant to Title 18, United States Code, Section 4241.

The provisions of this statute permit commitment to the custody of the Attorney General for 30

days.

Mr. X arrived at fill in name of institution on date. He would normally be approved for a

return to court on approximately date. However, fill in the reason why an extension is

necessary. Given this new development, we are respectfully requesting a 15-day extension.

In accordance with Title 18, United States Code, Section 4241, the Court may grant an additional

15-day period of time to complete the mental health evaluation. If the extension is granted, the

evaluation will be completed on or about date, and a written report will be submitted to the

Court. If the mental health evaluation is completed prior to the projected completion date, the

Court will be notified. If you have any questions or concerns about the proposed extension or the

details of the case, please contact me at number.

Sincerely,

Name of Warden,

WARDEN

P5070.12

4/16/2008

Attachment A

P5070.12

4/16/2008

Attachment B

Inmate Name: “Sample Contact Log”

Register Number:

Inmate Contacts Attorney Contacts Collateral Contacts

Date, Time, Length

Brief Notes

Date, Time, Length

Brief Notes

Date, Time, Length

Brief Notes

Date, Time, Length

Brief Notes

Date, Time, Length

Brief Notes

Date, Time, Length

Brief Notes

Date, Time, Length

P5070.12

4/16/2008

Attachment C

U.S. DEPARTMENT OF JUSTICE

Federal Bureau of Prisons

GENERAL GUIDELINES FOR TRANSMITTAL LETTER

Paragraph 1:

This paragraph will state that we are forwarding two copies of

the evaluation. It will mention the date of the sentence, type

of sentence, the offense, arrival date at the facility, and the

date the case is due in court (to include any extension

information).

Paragraph 2 (and additional paragraphs, if needed):

This paragraph will briefly respond to the court's referral

questions, highlighting major findings. If no questions were

posed by the court, then summarize the findings of the clinical

evaluation and any pertinent information from the observation

process.

Final Paragraph:

Inform the court that we will provide any additional information

the court may need.

P5070.12

4/16/2008

Attachment D

U.S. DEPARTMENT OF JUSTICE Complete in PDS

Federal Bureau of Prisons

Mental Health Evaluation - “Institution Disciplinary Process”

Institution: Date:

Name of Inmate:

Register Number:

Name of Evaluator:

REASON FOR REFERRAL AND IDENTIFYING INFORMATION: (source, reason

for referral, identifying information)

BACKGROUND INFORMATION: (history of mental illness, psychological

or psychiatric treatment, prior forensic evaluation)

CLINICAL INTERVIEW AND MENTAL STATUS EXAM: (results of brief

clinical interview and mental status exam, note limits of

confidentiality discussed)

CLINICAL IMPRESSION: (diagnosis if rendered, basis for diagnosis)

FINDINGS: (conclusions based on general criteria for competence

and/or responsibility)

The following language may be helpful for explanation:

A person is not responsible for his conduct if, at the time of

the conduct, the person, as a result of a severe mental disease

or defect, was unable to appreciate the nature and quality or the

wrongfulness of his/her acts. Some key criteria:

# Diagnosable mental disorder or defect.

# Lacked mental capacity to realize that he/she committed a

wrong.

# Did not appreciate why his/her behavior or conduct was

wrong.

# Could not stop his/her behavior (“irresistible impulse”).

A person is incompetent if he/she lacks the ability to understand

the nature of the disciplinary proceedings, or to assist in

his/her defense at the proceedings. Some key criteria:

# Understanding of charges against him/her.

# Understanding of the disciplinary process/proceedings.

# Can they participate in his/her own defense?

(Note: File in Central File - FOI Exempt - Section 2)