IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of ) ) ) ) ) Case No. a child ORDER FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING The court having been requested by the victim disclosure of the child's HIV test results FINDS that: victim's legal guardian minor victim's parent for The child, , is alleged by petition for delinquency to have committed has been adjudicated delinquent for a sexual offense proscribed in Florida Statutes, Chapter 794 or § 800.00, involving the transmission of body fluids from one person to another. It is ORDERED AND ADJUDGED that: 1. The child, Virus testing. , shall immediately undergo Human Immunodeficiency 2. The testing shall be performed under the direction of the Department of Health in accordance with Florida Statutes § 381.004. 3. The results of the test performed on the child pursuant to this order shall not be admissible in any juvenile proceeding arising out of the alleged sexual offense sexual offense. 4. The results of the test shall be disclosed, under the direction of the department, to the child and to the victim victim's legal guardian minor victim's parent. The department shall ensure that the provisions of Florida Statutes § 381.004, for personal counseling are available to the party requesting the test results. DONE AND ORDERED at , Florida, on , 20 . __________________________________ Circuit Judge Order For HIV Testing {8.949} American LegalNet, Inc. www.USCourtForms.com