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There's no definitive answer,all court proceedings are governed by state statutes. In some states only a judge reviews evidence and renders a decision. Other states there can be a competency board of three or more. In some instances a physician is appointed by the court to examine the individual, other states accept the medical evaluation of the person's doctor. In all cases the person has the right to appeal and even in some cases request a jury trial. Obviously it can be a simple or extremely complicated issue.

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