Form JD-JM-185 "Request by Victim to Test Child for Aids/Hiv - Juvenile Matters" - Connecticut

What Is Form JD-JM-185?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2010;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-JM-185 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-JM-185 "Request by Victim to Test Child for Aids/Hiv - Juvenile Matters" - Connecticut

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JUVENILE MATTERS
Instructions To Victim:
STATE OF CONNECTICUT
REQUEST BY VICTIM TO
Forward completed original and 3
SUPERIOR COURT
copies of this form to the clerk of
TEST CHILD FOR AIDS/HIV
court. Keep a copy for your records.
www.jud.ct.gov
JD-JM-185 New 10-10
Instructions To Clerk:
C.G.S. §§ 19a-581 to 19a-585, 54-102a, 54-102b
Maintain original in the court file.
P.A. 10-43 §41-42
Provide one copy to the State's
Attorney and one copy to the
To: The Superior Court for Juvenile Matters
child's attorney.
Address of court (Number, street, town and zip code)
Docket number
Name of Respondent child
Crime(s) charged against Respondent child
Name of victim
Address to which notice to victim is to be sent
Request That the Respondent Child Be Tested for AIDS/HIV
I, the victim signing below, make the following statements and request: ("X" all that apply)
1. The child named above is accused of violating section
53a-70 (sexual assault, 1st degree)
a violation of section 53-21 (injury or risk of injury
53a-70a (aggravated sexual assault, 1st degree)
to a child)
53a-70b (sexual assault in a spousal or cohabiting
53a-72a (sexual assault, 3rd degree)
relationship)
53a-72b (sexual assault, 3rd degree with a firearm)
53a-71 (sexual assault, 2nd degree)
53a-73a (sexual assault, 4th degree)
2. I am the victim of the crime.
3. I request that the child named above be tested: ("X" one or both)
As soon as possible
Upon the court entering a conviction of the child as delinquent
for AIDS or HIV (the presence of the etiologic agent for acquired immune deficiency syndrome or human
immunodeficiency virus) and that I be told the results.
I have read the above and understand it.
Signed (Victim/Consented to by Parent or Guardian of minor Victim/Attorney for Victim)
Date signed
I agree to the statements above.
Order Of The Court
It is ordered by the court:
Request Denied.
Request Granted. (C.G.S. § 54-102b requires granting request if the child is convicted as delinquent.)
If the child is convicted as delinquent, the Court Support Services Division of the Judicial Branch or the Department of Children
and Families is hereby ordered to have the child named above tested for the presence of the etiologic agent for acquired immune
deficiency syndrome or human immunodeficiency virus and to perform the test in consultation with the Department of Public
Health. The provisions of sections 19a-581 to 19a-585, inclusive, and section 19a-590 of the general statutes, except the
requirement that the subject of an HIV-related test provide informed consent prior to the performance of such test and except any
provision that would prohibit or limit disclosure of the results of such test to the victim, the court or the Department of Public
Health if so ordered below, shall apply to the test ordered and the disclosure of the results of such test.
If the child is not convicted as delinquent, the child shall forthwith select a Department of Public Health testing site from a list
provided by the clerk of the court and the testing site is hereby ordered to have the child named above tested for the
presence of the etiologic agent for acquired immune deficiency syndrome or human immunodeficiency virus. The provisions
of sections 19a-581 to 19a-585, inclusive, and section 19a-590 of the general statutes, except the requirement that the
subject of an HIV-related test provide informed consent prior to the performance of the test and except any provision that
would prohibit or limit disclosure of the results of the test to the victim, the court or the Department of Public Health if so
ordered below, shall apply to the test ordered and the disclosure of the results of such test.
The results of such test
Shall
Shall not
be disclosed to the victim.
(C.G.S. § 54-102b as amended by P.A. 10-43
requires disclosure of results to the victim if the child was convicted as delinquent.
§41-42
C.G.S. § 54-102a as amended by P.A. 10-43
makes disclosure discretionary with the court if the child is accused but not convicted as
§41-42
delinquent.)
A report of the results of such test shall be filed with the Department of Public Health, on a form supplied by it, and filed
with this court. ("X" only if the child is accused but not convicted as delinquent.)
By order of the court (Print or type name of Judge)
Date signed
Signed (Judge)
Print Form
Reset Form
JUVENILE MATTERS
Instructions To Victim:
STATE OF CONNECTICUT
REQUEST BY VICTIM TO
Forward completed original and 3
SUPERIOR COURT
copies of this form to the clerk of
TEST CHILD FOR AIDS/HIV
court. Keep a copy for your records.
www.jud.ct.gov
JD-JM-185 New 10-10
Instructions To Clerk:
C.G.S. §§ 19a-581 to 19a-585, 54-102a, 54-102b
Maintain original in the court file.
P.A. 10-43 §41-42
Provide one copy to the State's
Attorney and one copy to the
To: The Superior Court for Juvenile Matters
child's attorney.
Address of court (Number, street, town and zip code)
Docket number
Name of Respondent child
Crime(s) charged against Respondent child
Name of victim
Address to which notice to victim is to be sent
Request That the Respondent Child Be Tested for AIDS/HIV
I, the victim signing below, make the following statements and request: ("X" all that apply)
1. The child named above is accused of violating section
53a-70 (sexual assault, 1st degree)
a violation of section 53-21 (injury or risk of injury
53a-70a (aggravated sexual assault, 1st degree)
to a child)
53a-70b (sexual assault in a spousal or cohabiting
53a-72a (sexual assault, 3rd degree)
relationship)
53a-72b (sexual assault, 3rd degree with a firearm)
53a-71 (sexual assault, 2nd degree)
53a-73a (sexual assault, 4th degree)
2. I am the victim of the crime.
3. I request that the child named above be tested: ("X" one or both)
As soon as possible
Upon the court entering a conviction of the child as delinquent
for AIDS or HIV (the presence of the etiologic agent for acquired immune deficiency syndrome or human
immunodeficiency virus) and that I be told the results.
I have read the above and understand it.
Signed (Victim/Consented to by Parent or Guardian of minor Victim/Attorney for Victim)
Date signed
I agree to the statements above.
Order Of The Court
It is ordered by the court:
Request Denied.
Request Granted. (C.G.S. § 54-102b requires granting request if the child is convicted as delinquent.)
If the child is convicted as delinquent, the Court Support Services Division of the Judicial Branch or the Department of Children
and Families is hereby ordered to have the child named above tested for the presence of the etiologic agent for acquired immune
deficiency syndrome or human immunodeficiency virus and to perform the test in consultation with the Department of Public
Health. The provisions of sections 19a-581 to 19a-585, inclusive, and section 19a-590 of the general statutes, except the
requirement that the subject of an HIV-related test provide informed consent prior to the performance of such test and except any
provision that would prohibit or limit disclosure of the results of such test to the victim, the court or the Department of Public
Health if so ordered below, shall apply to the test ordered and the disclosure of the results of such test.
If the child is not convicted as delinquent, the child shall forthwith select a Department of Public Health testing site from a list
provided by the clerk of the court and the testing site is hereby ordered to have the child named above tested for the
presence of the etiologic agent for acquired immune deficiency syndrome or human immunodeficiency virus. The provisions
of sections 19a-581 to 19a-585, inclusive, and section 19a-590 of the general statutes, except the requirement that the
subject of an HIV-related test provide informed consent prior to the performance of the test and except any provision that
would prohibit or limit disclosure of the results of the test to the victim, the court or the Department of Public Health if so
ordered below, shall apply to the test ordered and the disclosure of the results of such test.
The results of such test
Shall
Shall not
be disclosed to the victim.
(C.G.S. § 54-102b as amended by P.A. 10-43
requires disclosure of results to the victim if the child was convicted as delinquent.
§41-42
C.G.S. § 54-102a as amended by P.A. 10-43
makes disclosure discretionary with the court if the child is accused but not convicted as
§41-42
delinquent.)
A report of the results of such test shall be filed with the Department of Public Health, on a form supplied by it, and filed
with this court. ("X" only if the child is accused but not convicted as delinquent.)
By order of the court (Print or type name of Judge)
Date signed
Signed (Judge)
Print Form
Reset Form