Order For Prison DOSA Screening Report {CR 84.0330}

Superior Court of Washington County of State of Washington, Plaintiff, v. ____________________________________, Defendant. DOB: CCN: No. Order for Prison DOSA Screening Report per RCW 9.94A.660 (ORDOSA) Offense: _________________________ [ ] Clerk's action required The court will consider imposing a sentence under the Prison Chemical Dependency Treatment-Based Alternative sentence (DOSA). The court hereby: Orders that the Defendant shall participate in a chemical dependency screening report with the Department of Corrections. Orders that the sentencing in this case shall occur on ____________, 20___, at ____am/pm before Judge ______________________ in Room _______ of the ____________________________County Courthouse. Orders that within 10 days of receiving this order, the screening report shall be faxed or delivered to the Court at (fax number or room number): _______________________, to the Prosecuting Attorney at (fax number): _______________________, to the Defendant (or Defense Counsel) (fax number): ______________________, and to the Department of Corrections Headquarters CD Unit. [] [] [] Defendant is residing in the community. Defendant's name, address and telephone number are: Defendant is incarcerated at: . Defense counsel's name and address are: _____________________________________________________________________________. _________________________________________ Judge __________________________ Defendant Print Name: Dated:____________________________ Presented By: ___________________________ ___________________________ Deputy Prosecuting Attorney Attorney for Defendant WSBA No. WSBA No. Print Name: Print Name: Or For Prison DOSA Screening Rpt (ORDOSA) Page 1 of 1 CR 84.0330 (12/2009) RCW 9.94A.660 American LegalNet, Inc. www.FormsWorkFlow.com