ORDER FOR MEDICAL TESTING
AND BODY SUBSTANCE SAMPLE
lex
et
justitia
C
O
M
M
O
N
W
E
A
L
T
H
O
F
K
E
N
T
U
C
K
Y
C
O
U
R
T
O
F
J
U
S
T
I
C
E
AOC-1025.1 Doc. Code: OTBS
Rev. 3-20
Page 1 of 2
Commonwealth of Kentucky
Court of Justice www.kycourts.gov
KRS 212.245; 212.245(6);
902 KAR 2:050
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
IN RE: MEDICAL TESTING / BODY SUBSTANCE SAMPLE OF ____________________________________________,
[Individual's Name]
8. The petitioner further has reasonable grounds to believe that ________________________________ poses a serious
and present threat to the health of others if he or she is infected with 2019-nCoV and is not tested.
[individual's name]
The COURT now MAKES the following conclusions:
1. Pursuant to 902 KAR 2:050 and KRS 212.245, the petitioner, in his or her role as ________________________ with
the _______________________________________________ is empowered to require _______________________
_________ to submit to medical testing to determine whether he/she is infected with 2019-nCoV.
[local health department name]
[petitioner’s title]
[individual's name]
[individual's name]
7. The petitioner, _________________________________________, an officer/employee of _____________________
_______________________________, has reasonable grounds, as set forth in the attached Affidavit, to believe that
________________________________ is infected with 2019-nCoV.
[petitioner’s name and title]
[local health department name]
5. Clear and convincing evidence shows that those people who are in physical contact with or in the proximity of less than
6 feet of an individual infected with this disease, or have had contact with a surface or object that is contaminated with
2019-nCoV, are likely to exhibit symptoms within 2 to 14 days, which period of time is referred to herein as the “incubation
period”. Thus, the clear and convincing evidence suggests that this disease is easily transmissible from person-to-person.
1. The _______________________________________________ has received reports of increasing numbers of ill people
exhibiting symptoms of a disease that has in its common course severe disability or death.
[local health department name]
3. 2019-novel Coronavirus (2019-nCoV) is a new communicable disease that has not been previously identified in the
world. 2019-nCoV meets the definition for “severe acute respiratory syndromes” as set forth in federal Executive Order
13295, as amended by Executive Order 13372 and 13674, and is a federally quarantinable communicable disease. It is
characterized by fever, cough, and shortness of breath and can progress to severe respiratory illness requiring
hospitalization and mechanical ventilation and can lead to death.
2. That since ______________________, 2_____ until the date of this Order, over ____________ people have been
stricken with this disease in Kentucky and ____________ people have died.
[applicable number]
[applicable number]
[date of first case report]
6. There are no known preventive medications for this disease at this time.
4. 2019-nCoV is spread from person-to-person among close contacts. According to the Center for Disease Control and
Prevention, person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected
person coughs or sneezes. These droplets can be inhaled into the lungs and in the mouths or noses of people who are
in close contact. Further, this disease may be spread from contact with contaminated surfaces or objects.
The COURT, having received evidence in this matter, and being otherwise sufficiently advised, now FINDS:
10. ________________________________ has refused to undergo said testing.
[individual's name]
[individual's name]
9. The petitioner has requested that ________________________________ voluntarily undergo medical testing to
confirm the presence of 2019-nCoV.
