Get This Is The Only Medical Reporting Form That Will Be ... - Maine.gov - Maine

Filling out the This Is The Only Medical Reporting Form That Will Be ... is essential for accurately reporting incidents related to alcohol levels and offenses. This guide provides step-by-step instructions to assist users in completing the form online effectively.

Follow the steps to properly fill out the medical reporting form online.

1. Click the ‘Get Form’ button to access the digital version of the form and open it in your preferred editor.
2. Begin by entering the name of the individual involved in the offense in the designated NAME field. Ensure it is spelled correctly to avoid any discrepancies.
3. Fill out the DATE OF OFFENSE field with the exact date when the incident occurred. Use the format MM/DD/YYYY for clarity.
4. Input the complete ADDRESS of the individual involved in the incident, which should include the street address, city, and zip code.
5. Note the TIME OF OFFENSE in the appropriate field, indicating when the incident took place.
6. Provide the DATE OF BIRTH (D.O.B.) of the individual in the corresponding field, following the same date format as before.
7. Record the ALCOHOL LEVEL in grams, as determined by any chemical tests performed during the incident.
8. Indicate the PLACE OF OFFENSE by entering relevant address or location information where the incident occurred.
9. Check all applicable boxes that correspond to the categories of the offense, such as ALC LEVEL, ANY ALC COND, PASS < 21 YRS, etc., ensuring that you select the appropriate descriptors for the situation.
10. In the OFFICER'S STATEMENT OF PROBABLE CAUSE section, provide a comprehensive account of the circumstances leading to the charge, including any observations made.
11. If an intoxilyzer test was conducted, ensure to include the certified results with the form before submitting.
12. After filling all necessary fields, save the changes made to the form. You can then download a copy, print for your records, or share it as required.

Complete your reporting form online today to ensure accurate and timely submission.