06.04.2014 Views

National Guidelines on Management of Sexual Violence in Kenya

National Guidelines on Management of Sexual Violence in Kenya

National Guidelines on Management of Sexual Violence in Kenya

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

PART 11-MEDICAL DETAILS - (To be completed by Medical Officer or Practiti<strong>on</strong>er carry<strong>in</strong>g out<br />

exam<strong>in</strong>ati<strong>on</strong>)<br />

(Please type four copies from the orig<strong>in</strong>al manuscript)<br />

SECTION ‘’A’’-THIS SECTION MUST BE COMPLETED IN ALL EXAMINATIONS<br />

Medical Officer’s Ref. No.____________________________________________________________<br />

1. State <strong>of</strong> cloth<strong>in</strong>g <strong>in</strong>clud<strong>in</strong>g presence <strong>of</strong> tears, sta<strong>in</strong>s (wet or dry) blood, etc.<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

2. General medical history (<strong>in</strong>clud<strong>in</strong>g details relevant to <strong>of</strong>fence)<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

3. General physical exam<strong>in</strong>ati<strong>on</strong> (<strong>in</strong>clud<strong>in</strong>g general appearance, use <strong>of</strong> drugs or<br />

Alcohol and demeanour)<br />

_________________________________________________________________________________<br />

__________________________________________________________________________________________<br />

This P3 Form is free <strong>of</strong> charge<br />

SECTION ‘’B’’- TO BE COMPLETED IN ALL CASES OF ASSAULT INCLUDING<br />

SEXUAL ASSAULTS<br />

COMPLETION OF SECTION ‘’A’’<br />

1. Details <strong>of</strong> site, situati<strong>on</strong>, shape and depth <strong>of</strong> <strong>in</strong>jures susta<strong>in</strong>ed:-<br />

a) Head and neck<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

b) Thorax and Abdomen.<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

c) Upper limbs<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

d) Lower limbs<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

50

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!