The State of Michigan

Defendant’s/Juvenile’s name, address, and telephone no.

v

THE PEOPLE OF    

 
 

 Juvenile     In the matter of 
 

Date

1. On 
 
 
 
 

  
                                                            
                                                            
                                                           
                                                           

 defendant/juvenile was arraigned on a warrant for:
 defendant was assigned to youthful trainee status for:
 defendant/juvenile was convicted of:
 defendant/juvenile was bound over to the circuit court for:
 juvenile was found to be within the provisions of MCL 712A.2 for violation of:

Specify (See reverse side for list of violations.)

                                                            
 
2. The defendant/juvenile is                    

 on bond.
 incarcerated in 

 

IT IS ORDERED:

3.The defendant/juvenile shall receive counseling regarding venereal disease, hepatitis B and C infection, human 
immunodeficiency virus (HIV) infection; acquired immunodeficiency syndrome; and acquired immunodeficiency syndrome 
 
related complex including, at a minimum, information regarding treatment, transmission, and protective measures from
 
                                                           
 
 
                                                           
                                                                

 a local health department, at the defendant’s/juvenile’s expense,
 an assigned counseling and testing agency, at the defendant’s/juvenile’s expense,
 a licensed physician, at the defendant’s/juvenile’s expense.

Name of physician or contact person of agency or health department and address

4. The defendant/juvenile shall be confidentially tested for venereal disease, hepatitis B and C infection, and for the presence 
  of HIV or an antibody to HIV from the agency or person providing the counseling. The person or agency administering the 
test shall transmit the test results and any other medical information obtained from the defendant/juvenile to this court. The 
 
 
test results will be made part of the court record but are confidential and shall be disclosed only to those specified in the 
  statute.

5. If authorized by the victim or victim’s representative, the victim advocate of the prosecuting office shall immediately forward
the name, address, and telephone number of the victim or the victim’s representative to the physician or agency administering
 
the test on the defendant/juvenile.
 

6. All testing and counseling of the defendant/juvenile must be completed and test results transmitted to the court

 

 before the sentencing/dispositional hearing date on 
 

 . 

 

 within 30 days of this order.

  Test results must be transmitted to 
 

 

 the 
 

 this court at the address stated above. Failure to comply may result in penalty for contempt of court. 

 circuit court at 
 

Date

 

Judge/Magistrate                                                                                   Bar no.

  See the other side for instructions and a list of persons subject to testing and counseling under MCL 333.5129.

 .

 .

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MC 234 (6/19) ORDER FOR COUNSELING AND TESTING FOR DISEASE/INFECTIONMCL 333.5129, MCL 333.5131Approved, SCAO Original - Court1st copy - Prosecuting attorney or victim advocate2nd copy - Defendant/Juvenile3rd copy - Testing agency/PhysicianSTATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITORDER FOR COUNSELING AND TESTINGFOR DISEASE/INFECTIONCASE NO.Court addressCourt telephone no.INSTRUCTIONS

1. Even if the defendant is convicted of a lesser offense, this form is to be used under MCL 333.5129 to order testing and
  counseling when a
 
 
 
 
 

•   defendant is arraigned on a warrant in the district court or bound over to circuit court for specific sex offenses as listed
    below when the district court determines there is reason to believe the violation involved sexual penetration or exposure
    to a body fluid of the defendant.
•   defendant is convicted of, or assigned to youthful trainee status for, specific sex offenses as listed below; or
•   juvenile is found to come under the provisions of MCL 712A.2 for violation of specific sex offenses as listed below.

2. Item 5 applies only if the victim has consented to the release of his/her name, address, and phone number on Department
  of Community Health form DCH 1253.

PERSONS SUBJECT TO TESTING AND COUNSELING UNDER MCL 333.5129

MCL 333.5129(1): An individual arrested and charged with violating one of the following sections of the penal code, or a local ordinance
prohibiting prostitution or engaging or offering to engage the services of a prostitute may, upon order of the court, be examined or tested to
determine whether the individual has venereal disease, hepatitis B infection, hepatitis C infection, HIV infection, or acquired immunodeficiency 
syndrome. Examination or test results that indicate the presence of venereal disease, hepatitis B infection, hepatitis C infection, HIV infection,
or acquired immunodeficiency syndrome shall be reported to the defendant and, pursuant to sections 5114 and 5114a, to the department and
the appropriate local health department of partner notification.
MCL 750.448                  Soliciting and accosting
MCL 750.449                   Admitting to place for purpose of prostitution
MCL 750.449a      
MCL 750.450        
MCL 750.452        
MCL 750.455        

Engaging services for purpose of prostitution, lewdness, or assignation, offer to engage; penalty
Aiders and abettors
House of ill fame, keeping, maintaining or operating
Pandering

MCL 333.5129(3): If a defendant is bound over to circuit court for a violation of one of the following sections of the penal code and the district
court determines there is reason to believe the violation involved sexual penetration or exposure to a body fluid of the defendant, the district 
court shall order the defendant to be examined or tested for venereal disease, hepatitis B infection, and hepatitis C infection and for the 
presence of HIV or an antibody to HIV.
MCL 750.145a      
MCL 750.338        
MCL 750.338a      
MCL 750.338b      
MCL 750.450        
MCL 750.452        
MCL 750.455        
MCL 750.520b      
MCL 750.520c      
MCL 750.520d      
MCL 750.520e      
MCL 750.520g      

Accosting, enticing, or soliciting child for immoral purposes
Gross indecency; between male persons
Gross indecency; between female persons
Gross indecency; between male and female persons
Aiders and abettors
House of ill fame, keeping, maintaining or operating
Pandering
First-degree criminal sexual conduct
Second-degree criminal sexual conduct
Third-degree criminal sexual conduct
Fourth-degree criminal sexual conduct
Assault with intent to commit criminal sexual conduct

MCL 333.5219(4): Except as otherwise provided in this section, upon conviction of a defendant or the issuance of an order adjudicating a child 
to be within the provisions of MCL 712A.2, for violating one of the following sections of the penal code, or by intravenously using a controlled 
substance, or a local ordinance prohibiting prostitution, solicitation, gross indecency, or the intravenous use of a controlled substance, the 
court having jurisdiction of the criminal prosecution or juvenile hearing shall order the defendant or child to be examined or tested for venereal 
disease, hepatitis B infection, and hepatitis C infection and for the presence of HIV or an antibody to HIV.
Use of controlled dangerous substance; penalties (specifically, intravenous use)
MCL 333.7404      
Accosting, enticing, or soliciting child for immoral purposes
MCL 750.145a      
Gross indecency; between male persons
MCL 750.338        
Gross indecency; between female persons
MCL 750.338a      
Gross indecency; between male and female persons
MCL 750.338b      
MCL 750.448                  Soliciting and accosting
MCL 750.449                   Admitting to place for purpose of prostitution
MCL 750.449a      
MCL 750.450        
MCL 750.452        
MCL 750.455        
MCL 750.520b      
MCL 750.520c      
MCL 750.520d      
MCL 750.520e      
MCL 750.520g      

Engaging services for purpose of prostitution, lewdness, or assignation, offer to engage; penalty
Aiders and abettors
House of ill fame, keeping, maintaining or operating
Pandering
First-degree criminal sexual conduct
Second-degree criminal sexual conduct
Third-degree criminal sexual conduct
Fourth-degree criminal sexual conduct
Assault with intent to commit criminal sexual conduct