Legal Blood Warrant Request

LEGAL BLOOD WARRANT REQUEST

Petitioner:   Badge/ID:   Agency:

Subject (Individual to be tested) Name:   DOB:

Location of detention or where sample is to be taken:

RECITALS

WHEREAS, on at approximately , petitioner responded to or observed an incident described as:

WHEREAS, petitioner has reasonable and articulable grounds to believe that the subject committed or was operating a vehicle while under the influence of alcohol or drugs, based upon officer observations, field sobriety testing, and observations recorded as follows:

WHEREAS, petitioner has been unable to obtain a voluntary sample from the subject for the following reason(s):

NOW THEREFORE, petitioner requests that a warrant be issued authorizing a qualified medical professional to lawfully obtain a blood sample from the subject and to preserve and deliver that sample for chemical analysis as set forth below.

1. AUTHORITY AND JURISDICTION

This request is made pursuant to the authority vested in judicial officers to issue search warrants for blood samples where probable cause exists to believe that evidence of impairment by alcohol or controlled substances will be obtained thereby. The facts set forth in this document support a finding of probable cause to issue a warrant to obtain such evidence.

2. FINDINGS OF PROBABLE CAUSE

Based on the facts sworn to by petitioner in the foregoing recitals and attachments, the judicial officer may find:

1. That petitioner had reasonable suspicion and probable cause to stop, detain, or arrest the subject for suspected impaired operation of a motor vehicle.
2. That the subject was either incapable of providing a voluntary sample, refused to consent to a sample, or exigent circumstances justified a compelled sample to prevent loss of evidence.
3. That a forensic blood test is reasonably likely to yield material evidence of impairment by alcohol or drugs.

Additional factual basis supporting probable cause (attach or state additional facts as needed):

3. WARRANT TO OBTAIN BLOOD SAMPLE

Upon review of the foregoing sworn statements and finding probable cause, the judicial officer is requested to issue a warrant authorizing any licensed physician, registered nurse, phlebotomist, or other qualified medical professional at: to draw a sufficient blood sample from the subject identified above for forensic testing, including but not limited to alcohol concentration and toxicology screening.

The authorized medical professional shall use standard sterile techniques and shall draw and preserve sufficient quantity of blood for the requested analyses and for any confirmatory testing by defense counsel.

4. SCOPE OF SEARCH AND SAMPLE HANDLING

The warrant shall authorize: (a) collection of venous blood in sterile containers as required by accredited forensic laboratories; (b) labeling of the sample with subject identifying information, date and time of collection, and the name of the person drawing the sample; and (c) sealing and preservation of the sample in a manner that protects against tampering and contamination.

Sample volume requested: . Tests requested:

5. CHAIN OF CUSTODY AND EVIDENCE PRESERVATION

The officer in charge shall ensure continuity of custody. The sample shall be placed in evidence storage or delivered to an accredited forensic laboratory as soon as practicable. The return or transfer shall include a signed chain of custody documenting dates, times, and all persons who handled the sample.

Chain of custody instructions:

6. SERVICE, NOTICE, AND RETURN

The officer executing this warrant shall make reasonable efforts to notify the subject of the order and, if applicable, shall afford the subject or the subject's counsel an inventory and opportunity to be present at the taking of the sample consistent with medical and safety concerns. A written return of the warrant, inventory of items seized, and a sworn statement of execution shall be filed with the issuing court within the time required by law.

7. IMMUNITY AND GOOD FAITH

All persons acting in good faith pursuant to the terms of this warrant, including requesting officers, medical personnel, and laboratory personnel, shall be afforded the immunity from civil and criminal liability provided under applicable law for actions taken in compliance with the warrant.

8. MISCELLANEOUS PROVISIONS

Governing Law: This request and any warrant issued hereunder shall be governed by the laws of the jurisdiction in which it is executed.

Entire Request: This document, together with any attachments and sworn statements incorporated herein, constitutes the entire request for a blood warrant and supersedes any prior oral requests concerning the same subject and facts.

Severability: If any provision of this request is held invalid, such invalidity shall not affect other provisions which can be given effect without the invalid provision.

Amendments/Waiver: This request may be amended only by written instrument signed by the petitioner and approved by the issuing judicial officer. No waiver by the issuing judicial officer of any provision shall be construed as a waiver of any other provision.

CERTIFICATION UNDER OATH

I, , hereby certify under penalty of perjury that the statements contained herein are true and correct to the best of my knowledge and belief, and that I make this request in good faith to preserve and collect evidence relevant to the investigation.

Sworn before me on: at .

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