Certification Of Blood Withdrawal

Florida DUI – Certification Of Blood Withdrawal

In Florida DUI cases involving the use of a blood test, there must be a Certification Of Blood Withdrawal. Here is what that form requires:

I certify that as a physician, certified paramedic, registered nurse, licensed practical nurse, or other person authorized by a hospital to draw blood, or as a licensed clinical laboratory director, supervisor, technologist or technician, I am authorized by 316.1932, 316.1933, 322.63, 327.352 and 327.353, Florida Statutes, to withdraw blood at the request of a law enforcement officer. I certify that on ______________________________ I withdrew blood from _______________________________________________________ at the request of _____________________________________. 
The blood sample(s) were collected and labeled in accordance with the provisions of Rule 11D-8.012, Florida Administrative Code. Before collecting the blood sample(s), the skin was cleansed with an antiseptic that did not contain alcohol. The blood sample(s) were collected in glass evacuation tubes that contained a preservative and an anticoagulant. Immediately after collection, the tubes were inverted several times. The blood collection tubes were labeled with the name of the person tested, the date and time the sample(s) were collected and the initials of the person who collected the sample(s).
_______________________________________________________________
(Printed name of person withdrawing blood)
_______________________________________________________________
(Title)
_________________________________________________          ____________
                                                                                                                                                                        (Signature)                                                                                  (Date)

May also be used in administrative proceedings pursuant to s. 322.2615, FloridaStatutes.  To be forwarded to the local Bureau of Driver Improvement Office, Division of Driver Licenses, Department of Highway Safety and Motor Vehicles.