IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, DIVISION OF PUBLIC HEALTH Petitioner, vs. Respondent. Minor ) ) ) ) ) ) ) ) ) Case No. REQUEST FOR HEARING TO CANCEL (VACATE) EX PARTE ORDER [AS 18.15.375(e)] CI A medical officer from the State of Alaska determined that you have been exposed to a contagious disease. The State asked the court for an ex parte order requiring you to be tested, examined, or screened for the disease. The court granted the State's request on and issued an ex parte order requiring you to undergo testing, examination, or screening. If you object to the court order, simply check the box below and return this form to the court. I object to the ex parte order requiring me to undergo testing, examination, or screening. I request a hearing to cancel (vacate) the ex parte order. Date Your Signature (Respondent) Your Phone Print Your Name Your Address CIV-792 (12/15)(cs) REQUEST FOR HEARING TO VACATE EX PARTE ORDER AS 18.15.375(e) American LegalNet, Inc. www.FormsWorkFlow.com