Order Following Hearing On Petition For Testing Of Infectious Disease
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Order Following Hearing On Petition For Testing Of Infectious Disease Form. This is a Michigan form and can be use in Infectious Disease Statewide.
Tags: Order Following Hearing On Petition For Testing Of Infectious Disease, MC 74, Michigan Statewide, Infectious Disease
STATE OF MICHIGAN
JUDICIAL DISTRICT COURT
JUDICIAL CIRCUIT COURT
ORDER FOLLOWING HEARING ON
PETITION FOR TESTING OF
Petitioner's name, address, and telephone no.
1. Date of Hearing:
Court telephone no.
Respondent's name, address, and telephone no.
2. A petition has been filed asserting that the individual named above 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 individual named above could have transmitted HIV, HBV, and/or HCV
to the employee, officer, or arresting individual.
IT IS ORDERED:
6. The petition is dismissed.
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.
7. The individual shall undergo testing for
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 individual named above shall pay the cost associated with implementing this order
including the charges for each test.
d. Within two 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.
MC 74 (3/08)
ORDER FOLLOWING HEARING ON PETITION FOR TESTING OF INFECTIOUS DISEASE
MCL 333.5205(7), (9)
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