Order Following Hearing On Petition For Testing Of Infectious Disease {MC 74} | Pdf Fpdf Doc Docx | Michigan

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Order Following Hearing On Petition For Testing Of Infectious Disease {MC 74} | Pdf Fpdf Doc Docx | Michigan

Order Following Hearing On Petition For Testing Of Infectious Disease {MC 74}

This is a Michigan form that can be used for Infectious Disease within Statewide.

Alternate TextLast updated: 8/16/2006

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Approved, SCAO STATE OF MICHIGAN CASE NO. ORDER FOLLOWING HEARING ON JUDICIAL DISTRICT COURT JUDICIAL CIRCUIT COURT PETITION FOR TESTING OF INFECTIOUS DISEASE COUNTY Court address Court telephone no.In the matter of 1. Date of Hearing: Judge: Bar no.2. A petition has been filed asserting that the above named individual was requested to undergo testing for infectious disease in accordance with MCL 333.5205 and refused to do so. 3. Notice of hearing has been given according to law. THE COURT FINDS: 4. The allegations of the petition have not been proven by clear and convincing evidence. 5. By clear and convincing evidence that the individual has refused to comply with the request for testing, that the employee, officer, or arresting individual named in the petition sustained a percutaneous, mucous membrane, or open wound exposure to the blood or body fluids of the individual, and that the above named individual could have transmitted HIV, HBV, and/or HCV to the employee, officer, or arresting individual. IT IS ORDERED: 6. The petition is dismissed. HIV 7. The individual shall undergo testing for HBV by . HCV Name of local health department or health care provider a. The employer shall transport the individual within 24 hours to the agency/facility named above for testing. b. A representative of the agency or facility shall within 24 hours come to where the individual is held or housed to take blood or other body fluid sample for testing. c. The local health department or designated health care provider that performs the test(s) may charge the reasonable and customary charges for each test. The above named individual shall pay the cost associated with implementing this order including the charges for each test. d. Within 2 days after the test results are obtained, the local health department or designated health care provider shall transmit the test results directly to the employee, officer, or arresting individual or, upon request, to his or her primary care physician or another health professional. Date Judge Do not write below this line - For court use only MCL 333.5205(7), (9); MSA 14.15(5205)(7), (9)MC 74 (5/00) ORDER FOLLOWING HEARING ON PETITION FOR TESTING OF INFECTIOUS DISEASE

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