Fillable AFFIDAVIT OF REFUSAL OF EXAMINATION (State of Ohio)

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AFFIDAVIT OF REFUSAL OF EXAMINATION (State of Ohio)

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PROBATE COURT OF ________________ COUNTY, OHIO
_____________, JUDGE
IN THE INTEREST OF: ______________________________________________________
CASE NO. __________
AFFIDAVIT OF REFUSAL OF EXAMINATION
[R.C. 5119.93(C)(1)]
I, ___________________________________________, Petitioner, filed in this Court a
Petition on ________________________alleging that _______________________________,
Respondent, is a person in need of substance abuse treatment by Court Order.
Respondent has refused all requests made by me, the Petitioner, to undergo a
physician’s examination concerning the possible need for substance abuse treatment.
__________________________________ .
Petitioner’s Printed Name
__________________________________ .
Petitioner’s Signature
Sworn to and signed in my presence on __________ day of________________________, 20_____.
__________________________________ .
Notary Public
FORM 26.2 – AFFIDAVIT OF REFUSAL OF EXAMINATION
Effective Date: July 1, 2016
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AFFIDAVIT OF REFUSAL OF EXAMINATION (State of Ohio)

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Completed 25 May 2022

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