Sexual Assault Forensic Medical Documentation Form
The Forensic Medical Documentation Form is used by medical professionals to document the medical examination of a patient who has alleged sexual assault. The form includes sections for the patient's medical history, the details of the examination, and the medical professional's findings and conclusions.
Time to complete
3 minutes
Eligibility
A medical professional who has examined a patient who has alleged sexual assault is eligible to fill out the Forensic Medical Documentation Form.
Questions for Sexual Assault Forensic Medical Documentation Form
1.
Patient's Name:
The answer should be a text input.
2.
Patient's Age:
The answer should be a single choice:
- Under 18
- 18-24 years old
- 25-34 years old
- 35-44 years old
- 45-54 years old
- Over 55
3.
Patient's Gender:
The answer should be a single choice:
- Male
- Female
- Other
- Prefer not to say
4.
Patient's Date of Birth:
The answer should be a date input.
5.
Patient's Address:
The answer should be a text input.
6.
Patient's Phone Number:
The answer should be a phone number.
7.
Patient's Email Address:
The answer should be an email input.
8.
Date of Exam:
The answer should be a date input.
9.
Time of Exam:
The answer should be a text input.
10.
Location of Exam:
The answer should be a text input.
11.
Referring Physician:
The answer should be a text input.
12.
Reason for Exam:
The answer should be a text input.
13.
Patient's History:
The answer should be a text input.
14.
Sexual Assault History:
The answer should be a text input.
15.
Physical Exam Findings:
The answer should be a text input.
16.
Medical Professional's Findings and Conclusions:
The answer should be a text input.
17.
Recommended Course of Treatment:
The answer should be a text input.
18.
Patient's Signature:
The answer should be a text input.
19.
Medical Professional's Signature:
The answer should be a signature.
20.
Date:
The answer should be a date input.
Similar Ideas
- Police Report
- Incident Report
- Victim Statement
- Witness Statement
- Autopsy Report
Here are some FAQs and additional information
on Sexual Assault Forensic Medical Documentation Form
What is the purpose of the Sexual Assault Forensic Medical Documentation Form?
The Forensic Medical Documentation Form is used to document the medical examination of a sexual assault victim.
Who should complete the Sexual Assault Forensic Medical Documentation Form?
A medical professional should complete the Forensic Medical Documentation Form.
What information should be included in the Sexual Assault Forensic Medical Documentation Form?
The Forensic Medical Documentation Form should include the victim's medical history, a description of the sexual assault, and the results of the medical examination.
How long does the Sexual Assault Forensic Medical Documentation Form need to be kept on file?
The Forensic Medical Documentation Form should be kept on file for at least five years.
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