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DUI COURT TRACKING SHEET Dawson County Superior Court Potential Client Information (Please Complete Criminal Justice Section on Reverse Side of Form) _____________________________ _______ _______________________________ _________________ First Name MI Last Name Date of Arrest _____________________ _________________________ ______ _______ _____________________ Date of Birth Social Security # Race Sex Ethnicity (1) District Attorney Initial Review (2) Defense Attorney Conference Eligible _______ DUI Court Selected ____ DUI Court Declined ____ Comments: ____________________________________ Comments:_____________________________________ ______________________________________________ ___________________________________________ ______________________________________________ __________________________________________ By:______________________________ ___________ By:_______________________________ _______ Print Name Initials Print Name Initials (3) Staff Assessment (4) District Attorney Final Review Recommended ______ Not Recommended ______ Recommended ______ Not Recommended ______ If not recommended, state reasons __________________ If not recommended, state reasons __________________ ___________________________________________ ______________________________________________ __________________________________________ ______________________________________________ By:_______________________________ _______ By:_________________________________ _________ Print Name Initials Print Name Initials (5) Team Review Selected _____ Not Selected _____ Decision Deferred ______ Awaiting Information _____ Other _____ If not selected, state reasons _________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ By:___________________________________ _________ Date______________________________ Print Name Initials (6) Court Action Approved for DUI Court Treatment ______________________ Defendant Declined DUI Court Treatment _________________ Judge ___________________________________________________ Date _________________________ (Instructions on back) September 2006 Instructions for DUI Court Tracking Sheet The DUI Court Tracking Sheet is designed to be a record of a client’s progress through the screening phase of the dui court program. It is important that a tracking sheet be initiated on any client who is eligible for treatment. The “Potential Client Identification” data should be completed by the District Attorney’s (DA) office. “Ethnicity” should be included, if known, to indicate affiliation with any ethnic group, i.e. Hispanic, Puerto Rican, Honduran, etc. The person who determines that the client is eligible for dui court should complete block number (1), “District Attorney Initial Review.” The DA screening team member should bring to the next screening meeting the “DUI Court Tracking Sheet” for each individual to be screened on that date. Blocks (2), (3) and (4) should be completed at the screening meeting by the appropriate team member. The screening team’s decision should be recorded in block (5) by the DUI court services secretary or team recording secretary, who is also responsible for the thorough completion of the tracking sheet. On dui court day, the dui court services secretary is responsible for assuring that the original, completed “DUI Court Tracking Sheet” for each client scheduled to appear is on the judge’s bench at the beginning of dui court. The presiding judge should complete block (6), “Court Action,” sign, and date the form. DUI Court Tracking Sheet Distribution The dui court services secretary is responsible for the proper filing and distribution of the tracking sheet as follows: A. Original to be kept with the client’s file at the treatment center. B. One copy for the judge’s file. C. One copy to be kept in a separate tracking sheet file for each calendar year at the treatment center. D. Copies to other team members as required. The following area should be used to continue comments from the other side, if additional space is needed. Please refer by number to the state continued. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ [(Questions? Call the Dawson County Treatment Center at (706) 265-8425.)] September 2006
"DUI COURT TRACKING SHEET"