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F.C.A.§ 1027 Form 10-3 (Child Protective –Order Directing Medical Examination) 8/2010 At a term of the Family Court of theState of New York, held in and for the County of , at New Yorkon . P R E S E N T: Hon. Judge ______________________________ In the Matter of Docket No. CIN #A Child Under the Age of ORDER DIRECTING Eighteen Years Alleged to be (Abused) MEDICAL (and) (Neglected) by EXAMINATION Respondent(s) ______________________________ A petition under Article 10 of the Family Court Act having been filed in this Court in the aboveentitled proceeding alleging that the above-named child is Gabused G neglected; it is herebyORDERED that is appointed to examine the child and during suchexamination shall arrange to have colored photographs taken of any areas of visible trauma,(check if applicable) G and shall arrange to have a radiological examination performed on the child; andit is further ORDERED that the physician, upon the completion of said examination shall forthwith forwardthe results thereof, together with the colored photographs (check if applicable) G and x-raysto this Court, and return the child to ; and it is further ORDERED thatPURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THEATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST.ENTER_____________________________________Judge of the Family CourtDated: , . Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________