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AOC-1025.4 Doc. Code: OFIS
Rev. 3-20
Page 1 of 3
Commonwealth of Kentucky
Court of Justice www.kycourts.gov
KRS 212.245; 902 KAR 2:030, 050
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
IN RE: ISOLATION OF ___________________________________________________________,
[Individual's Name]
ORDER FOR ISOLATION OF INDIVIDUAL
PURSUANT TO 902 KAR 2:030
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]
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]
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.
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.
7. The most effective method currently known to medical science to contain and curtail the spread of this disease is the
isolation of anyone who has the symptoms identified above at Paragraph 3, and the quarantine of those who have been
exposed to a person infected with this disease for the duration of the incubation period, as identified above at Paragraph 5.
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.
8. The affidavit and/or testimony of qualified witnesses, including ___________________________________________
______________________________________________________________________________, has indicated that
________________________________________ has tested positive for 2019-nCoV.
[individual's name]
[names and titles of relevant witnesses]
[names and titles of relevant witnesses]
9. The affidavit and/or testimony of qualified witnesses, including ___________________________________________
________________________________________________________________________________, has indicated
that ________________________________________ comes into contact with numerous individuals on a regular
basis through his/her activities as _________________________________________________________________
and that ________________________________________ has undertaken these activities since becoming infected
with this disease.
[individual's name]
[individual's name]
[names and titles of relevant witnesses and describe their association with the individual]
[names and titles of relevant witnesses and describe their association with the individual]
[list applicable profession or personal undertakings]
The COURT, having received evidence in this matter, and being otherwise sufficiently advised, now FINDS:
