school(s).
The investigator shall also be permitted to consult with any teachers, administrators, counselors or other staff
regarding the child or children who are the subject of the investigation in this case without the necessity of written
consent of the parent(s), guardian(s) or custodian(s).
Upon presentation of a copy of this court order, issued in compliance with 45 C.F.R. 164.512, to any
agency, hospital, organization, school, person, or office including but not limited to the Clerk of Court, human
services agencies, public children services agencies, private child placing agencies, pediatricians, psychiatrists,
other physicians, psychologists, counselors, or law enforcement agencies, the Family Assessment Investigator
shall be permitted to inspect and copy any records regarding the child(ren), including treatment for physical and
mental illness, and/or drug abuse, and/or AIDS (Acquired Immunodeficiency Syndrome), and/or the results of an
HIV test or the fact that an HIV test was performed, relating to the child(ren) without the consent of the child(ren)
or the child’s parent(s) or legal guardian(s), and to discuss with the person providing the treatment or tests in issue
all matters pertinent to treatment and findings related to the child(ren). At the conclusion of the case, the Family
Assessment Investigator shall maintain the confidentiality of records received pursuant to this order.
OTHER ORDERS: ____________________________________________________________________
__________________________________________________________________________________________
Pursuant to Civil Rule 41(B)(1) the parties are hereby given notice that failure to comply with the home investigation
as ordered herein may result in the dismissal of their action or claim for relief or result in a delay of the case.
The next hearing date in this matter is scheduled for ______________________, 20____, at ___________ a.m/p.m.
in courtroom ____, 373 S. High Street, Columbus, Ohio 43215.
IT IS SO ORDERED.
Signature Page Attached
Effective date:_________________________
JUDGE/MAGISTRATE
DATE
CC:
_______________________________________
____________________________________
Plaintiff/Petitioner
Defendant/Respondent
_______________________________________
____________________________________
Plaintiff/Petitioner
Defendant/Respondent
_______________________________________
____________________________________
Attorney for Plaintiff/Petitioner
Attorney for Defendant/Respondent
Family Assessment Department, Franklin County Court
of Common Pleas, Division of Domestic Relations
and Juvenile Branch
(e0500 3/2016)
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