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Table of Contents


Acknowledgements

Forward

Introduction

A. Foundation for Response During the Exam Process

A1. Principles of Care

A2. Adapting Care for Each Child

A3. Coordinated Team Approach

A4. Health Care Infrastructure

A4a. Pediatric Examiners

A4b. Facilities

A4c. Equipment and Supplies

A5. Infrastructure for Justice System Response During the Exam Process

A5a. Reporting

A5b. Confidentiality and Release of Information

A5c. Evidentiary Kits and Forms

A5d. Timing of Evidence Collection

A5e. Evidence Integrity

A5f. Payment Issues

B. Exam Process

B1. Consent for Care

B2. Initial Response

B3. Entry into the Health Care System

B4. Written Documentation

B5. Medical History

B6. Photo-Documentation

B7. Examination

B8. Evidence Collection

B9. Sexual Abuse Facilitated by Alcohol and Drugs

B10. Sexually Transmitted Disease Evaluation and Care

B11. Discharge Planning and Follow-Up Care

Glossary and Acronyms

References

Appendix 1. Tanner Stages of Sexual Maturation

Appendix 2. Illustrations of Exam Positions and Techniques

Appendix 3. Labeled Diagrams of Genital Anatomy

Appendix 4. Customizing a Community Protocol

Appendix 5. Impact of Crawford v. Washington and The Confrontation Clause

Appendix 6. Initial Response Algorithm

Appendix 7. Care Algorithm

Appendix 8. Prepubescent STD Testing Algorithm

Appendix 9. HIV Testing nPEP Algorithm

Appendix 10. Participants in Protocol Development

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The International Association of Forensic Nurses is a professional membership organization. If you are the victim of a crime, get help here.
If you are in immediate danger, call 911.

Since 2004, IAFN has partnered with a multidisciplinary group of subject matter experts to provide training and technical assistance around implementing the National Protocols along with the corresponding SAFEta.org website.
IAFN has partnered with a multidisciplinary group of subject matter experts to develop and disseminate training and techincal assistance around implementing options surrounding billing, coding and reimbursement processes related to the sexual assault medical forensic exam.
IAFN has partnered with a multidisciplinary group of subject matter experts (SMEs) to provide technical assistance (TA), resources, and education dedicated to improving the response to sexual violence in Tribal communities through the National Tribal Clearinghouse on Sexual Assault, a comprehensive resource hub.
IAFN has partnered with a multidisciplinary group of subject matter experts to determine the best practices for delivering medical forensic examinations to individuals who have experienced domestic violence. The target audience are healthcare clinicians and other first responders.

Copyright© 2006-2024 International Association of Forensic Nurses. All rights reserved worldwide. No materials, including graphics, may be reused, modified, or reproduced without written permission. Any questions or comments regarding this site should be directed to info@forensicnurses.org

This project was supported by Grant No.15JOVW-23-GK-05172-MUMU awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this Web Site are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

The Medical Forensic Exam Payment TA project was supported by Grant No.15JOVW-22-GK-04021-STOP awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this Web Site are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

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The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

Close

The following video depicts a brief, simulated patient encounter. These videos are intended to demonstrate clinical skills highlighting how to interact with patients using a trauma-informed approach. Each video prioritizes addressing the healthcare needs of the patient. The video does not show the medical forensic exam in its entirety but rather highlights portions of the exam.

A complete medical forensic exam includes but is not limited to:

  • Offering a confidential advocate
  • Consent for care
  • Medical history
  • Physical examination
  • Evidence collection & photo documentation
  • Diagnosis & treatment
  • Safety planning, discharge & follow-up care instructions

CONTENT WARNING: The following videos contain material that may be triggering and/or content that is challenging to view. Themes can include:  sexual assault, intimate partner violence, child sexual abuse, discrimination, racism, human trafficking, incarceration, and abuse later in life.

Continue

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