New York Family Court 3-17: Capacity Exam Report

In a New York juvenile delinquency case, the Family Court can order an examination under Family Court Act section 322.1 to decide whether the respondent is an incapacitated person as defined in section 301.2(13). This two-page report records whether the respondent was examined as possibly mentally ill or intellectually disabled, when and where, and the examiner's opinion on capacity.

Who completes it

Each court-designated examiner, a qualified psychiatrist or certified psychologist, completes and signs the whole report, striking out the title that does not apply. No other party completes part of it.

Submitting and payment

How to submit it
File the signed report with the Family Court that ordered the examination, under the case's docket number. The court posts the form as both a PDF and a Microsoft Word file.

Good to know

  • Item 1 cites the court order directing the examination and its date, and records up to two examination dates and locations.
  • Items 3 and 4 are required only when the examiner finds the respondent incapacitated: a diagnosis, a prognosis and a detailed statement of the reasons for the opinion.
  • The reasons must refer specifically to the parts of the proceedings the respondent cannot understand or in which they cannot assist in their own defense.
  • The current form is dated 6/2016. The court can extend the deadline with an Order Extending Time for Examination to Determine Capacity.

Get the official form

Download the current version from the source each time; forms change without notice.

Examination Report to Determine Capacity

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who completes New York Family Court form 3-17?

A qualified psychiatrist or certified psychologist whom the Family Court has designated to examine the juvenile respondent. Each examiner reports whether, in their professional judgment, the respondent is or is not an incapacitated person under section 301.2(13) of the Family Court Act, then signs and dates the report.

What does form 3-17 require if the respondent lacks capacity?

A note to the examiner says items 3 and 4 must be completed when incapacity is found. Item 3 gives the diagnosis and prognosis behind the opinion. Item 4 is a detailed statement of reasons that refers particularly to the aspects of the proceedings the respondent cannot understand or help with.

Is there a Word version of New York form 3-17?

Yes. The New York State Unified Court System posts the Examination Report to Determine Capacity as a PDF and as a Microsoft Word file on its statewide Family Court forms page, under juvenile delinquency. Examiners can type the report, then print, sign and file it with the court.