F.C.A.§ 1027 Form 10-3 (Child Protective ­ Order Directing Medical Examination) 8/2010 At a term of the Family Court of the State of New York, held in and for the County of , at New York on . P R E S E N T: Hon. Judge ______________________________ In the Matter of Docket No. CIN # A Child Under the Age of Eighteen Years Alleged to be (Abused) (and) (Neglected) by Respondent(s) ______________________________ ORDER DIRECTING MEDICAL EXAMINATION A petition under Article 10 of the Family Court Act having been filed in this Court in the above entitled proceeding alleging that the above-named child is Gabused G neglected; it is hereby ORDERED that is appointed to examine the child and during such examination shall arrange to have colored photographs taken of any areas of visible trauma, (check if applicable) G and shall arrange to have a radiological examination performed on the child; and it is further ORDERED that the physician, upon the completion of said examination shall forthwith forward the results thereof, together with the colored photographs (check if applicable) G and x-rays to this Court, and return the child to ; and it is further ORDERED that PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER _____________________________________ Judge of the Family Court Dated: ,. Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com