Annex 1: Medical evidence form

Name, rank and signature of officer in charge:………………………............

Filled in by physician:

Place of examination:………………………... Date and hour:…………………………………………………………

Statement of person examined by physician regarding his status (if there are any statements):……………………………………………………………………………………………

In case of harm or death:

Description of harm (in understandable terms):

…………………………………………………………………………………………………

Is it a critical case?

…………………………………………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………..

Physician’s opinion about probable cause of harm or death:

………………………………………………

In case of drunkenness

Blood Alcohol Rate:

(a) First degree drunk?

(b) Lightly affected by alcohol?

(c) Breathing of alcohol but in apparent good shape?

(d) Sober?

(e) Was he driving the vehicle safely?

Physician’s signature (who did the examination)

Rank and job:

Note: Medical examination in this form isn’t inconsistent with article 228 of law of criminal procedures

Note: The first two pages of this annex are an English translation of the Form 8 in Arabic on the following page. In many police stations, a Form 8 is not available and is sometimes drawn out by hand.