Front of Card:

MEDICAL INFORMATION FOR POLICE

I have the birth defect Fetal Alcohol Syndrome/Fetal Alcohol Effects, which causes brain damage. If I need assistance, or if you need my cooperation, you should contact the person listed on the back of this card.

Because of this birth defect, I do not understand abstract concepts like legal rights. I could be persuaded to admit to acts that I did not actually commit. I am unable to knowingly waive any of my constitutional rights, including my Miranda rights.

Because of my disability, I do not wish to talk with law enforcement officials except in the presence of and after consulting with an attorney. I do not consent to any search of my person or property.

Back of Card:

For information or assistance regarding:

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Please contact:

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Doctor or diagnostician:

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