GROUP EMERGENCY DETENTION ORDER
The group described herein, ____________________, (description of group, including number of individuals within the group) and named individually on the attached Confidential Schedule, is hereby ordered to detention at:
_____________________________
(premises subject to isolation and quarantine)
pursuant to WAC 246-100-040 et seq.. Your isolation or quarantine
commences on _____________ and _______________________.
(date) (time)
This Order will remain in effect until __________ and ________,
(date) (time)
unless otherwise rescinded, but not to exceed 10 days.
Suspected Communicable Disease or Infectious Agent if Known: __________
_________________________________
Reasons for Isolation of Entire Group, Including Reason for Grouping of Detention Order (Examples include, but are not limited to, a group that came in on a ship or airplane):
_________________________________________
_________________________________________
_________________________________________
Measures Taken by Local Health Officer to Seek Voluntary Compliance OR Basis For Which Local Health Officer Determined Seeking Voluntary Compliance Would Create Risk of Serious Harm:
[ ] The group has refused the local health officers attempt to obtain voluntary compliance.
[ ] The local health officer has determined that seeking your voluntary compliance of the group would create an imminent risk of serious public harm. This determination was based upon the following:
_______________________________
_______________________________.
[ ] Other:_______________________________
______________________________________.
Medical Basis on Which Decision to Isolate or Quarantine Is Justified:
[ ] The group is suspected of having been exposed to ___________ and is potentially currently infectious to others..
[ ] The group has been diagnosed with an active case of ______________ and is in all likelihood currently infectious to others.
[ ] Other: ______________________________
_____________________________________
_____________________________________
_____________________________________.
Special Instructions:
_____________________________________
_____________________________________
_____________________________________
It is very important for the protection of your own health and that of others that this group abide by this emergency detention order. If you have any questions about this order or need assistance in complying, please call: _________________.
The Health Officer may petition the Superior Court for an order authorizing continued isolation or quarantine for a period up to 30 days.
__________________________________________
Local Health Officer or His Designee
Tacoma-Pierce County Health Deptartment.
IMPORTANT NOTICE
You have the right to a petition the Superior Court for release from isolation or quarantine in accordance with WAC 246-100-055. You have the right to legal counsel. If you are unable to afford legal counsel, then counsel will be appointed for you at government expense and you should request the appointment of counsel at this time. If you currently have legal counsel, then you have an opportunity to contact that counsel for assistance.
I, __________________________________________, (group member) acknowledge that I have received a copy of the Emergency Detention Order, and that I have read or had read to me said Order and understand the terms therein.
Signed _________________. Dated this _______ day of _____________, 200___.
Internal use only:
Dated this ___________________day of __________, 20_____.
Date copies of Written Order was delivered to person or group of persons: _______________________. Method of delivery: personal service______; registered mail_____. If the order relates to a group and the order is posted, date and location of posting: _____________.
The group described herein, ____________________, (description of group, including number of individuals within the group) and named individually on the attached Confidential Schedule, is hereby ordered to detention at:
_____________________________
(premises subject to isolation and quarantine)
pursuant to WAC 246-100-040 et seq.. Your isolation or quarantine
commences on _____________ and _______________________.
(date) (time)
This Order will remain in effect until __________ and ________,
(date) (time)
unless otherwise rescinded, but not to exceed 10 days.
Suspected Communicable Disease or Infectious Agent if Known: __________
_________________________________
Reasons for Isolation of Entire Group, Including Reason for Grouping of Detention Order (Examples include, but are not limited to, a group that came in on a ship or airplane):
_________________________________________
_________________________________________
_________________________________________
Measures Taken by Local Health Officer to Seek Voluntary Compliance OR Basis For Which Local Health Officer Determined Seeking Voluntary Compliance Would Create Risk of Serious Harm:
[ ] The group has refused the local health officers attempt to obtain voluntary compliance.
[ ] The local health officer has determined that seeking your voluntary compliance of the group would create an imminent risk of serious public harm. This determination was based upon the following:
_______________________________
_______________________________.
[ ] Other:_______________________________
______________________________________.
Medical Basis on Which Decision to Isolate or Quarantine Is Justified:
[ ] The group is suspected of having been exposed to ___________ and is potentially currently infectious to others..
[ ] The group has been diagnosed with an active case of ______________ and is in all likelihood currently infectious to others.
[ ] Other: ______________________________
_____________________________________
_____________________________________
_____________________________________.
Special Instructions:
_____________________________________
_____________________________________
_____________________________________
It is very important for the protection of your own health and that of others that this group abide by this emergency detention order. If you have any questions about this order or need assistance in complying, please call: _________________.
The Health Officer may petition the Superior Court for an order authorizing continued isolation or quarantine for a period up to 30 days.
__________________________________________
Local Health Officer or His Designee
Tacoma-Pierce County Health Deptartment.
IMPORTANT NOTICE
You have the right to a petition the Superior Court for release from isolation or quarantine in accordance with WAC 246-100-055. You have the right to legal counsel. If you are unable to afford legal counsel, then counsel will be appointed for you at government expense and you should request the appointment of counsel at this time. If you currently have legal counsel, then you have an opportunity to contact that counsel for assistance.
I, __________________________________________, (group member) acknowledge that I have received a copy of the Emergency Detention Order, and that I have read or had read to me said Order and understand the terms therein.
Signed _________________. Dated this _______ day of _____________, 200___.
Internal use only:
Dated this ___________________day of __________, 20_____.
Date copies of Written Order was delivered to person or group of persons: _______________________. Method of delivery: personal service______; registered mail_____. If the order relates to a group and the order is posted, date and location of posting: _____________.
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