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Medical history:
STATE OF ALASKA Victim Sexual Assault Evidence Kit Medical History – Step 1B TO BE COMPLETED BY THE MEDICAL PROVIDER
Time assessment started: _________________
pm Time assessment ended: ________________
MEDICAL HISTORY:
If yes, list: ___________________________________________________________
If yes, list: _________________________________________________________________________
Vaccine History: Current medications (prescriptions, contraceptives, over-the-counter, herbal or home remedies):
If yes, list __________________________________________________________________________
Is the victim currently being treated for any chronic medical or mental health conditions that may impact the exam?
If yes, describe ____________________________________________________________________________________
_______________________________________________________________________________________________________________
Is the victim at risk of having withdrawal/DT’s during the exam?
If yes, is there a seizure history associated with withdrawal?
Does the victim have any observed disabilities?
If yes, describe ____________________________________________________________________________________
_______________________________________________________________________________________________________________
Does the victim have a safe living environment to return to?
Any recent medical procedures/treatments (30 days) that may affect the interpretation of any physical or forensic findings?
If yes, describe __________________________________________________________________________________________________
Did the victim seek medical care prior to this examination that may affect the interpretation of any physical findings or potential forensic evidence?
If yes, describe __________________________________________________________________________________________________
Where: _____________________________________________ Reason for care: _________________________________________
Page 1 of 4 Rev. Date – Aug/23/2013 STATE OF ALASKA Victim Sexual Assault Evidence Kit Medical History – Step 1B GYNECOLOGICAL HISTORY: LMP: _____________________________ Was LMP normal (per victim):
If no, describe ___________________________________________________________________________________________________
G __________ P ___________ Delivery in the last 8 weeks:
Does victim think she could be pregnant?
If yes, how many weeks: _________________________________________
Has victim been treated for an STI in the last 6 weeks?
Date: ___________________ For: _____________________________ Treated with: ________________________________
PHYSICAL ASSESSMENT:
Other: _______________________________________________
Vital Signs: General:
Yes If yes, current pain level per victim is: ______ out of 10 (0 = none, 10 = worst possible)
Location of pain: _________________________________________________________________________________________
Type of pain: ____________________________________________________________________________________________
What makes pain worse: ___________________________________________________________________________________
What makes pain better: ___________________________________________________________________________________
Additional information: ____________________________________________________________________________________
ANOGENITAL EXAM SUMMARY:
Was any discharge noted prior to or during manipulation of tissue (prior to insertion of speculum)?
If yes, describe _______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________ Was TBD used?
If no, explain: __________________________________________
If no, explain: __________________________________________
Other: _____________________________________________________
if no, explain: ________________________________________________________________
if no, explain: __________________________________________________
Did the victim complain of pain or experience pain during the exam?
If yes, describe _______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Page 2 of 4 Rev. Date – Aug/23/2013 STATE OF ALASKA Victim Sexual Assault Evidence Kit Medical History – Step 1B ANATOMICAL SITE: DESCRIBE:
LABORATORY TESTING/SPECIMENS COLLECTED:
RESULTS OBTAINED AT TIME OF EXAM: Page 3 of 4 Rev. Date – Aug/23/2013 STATE OF ALASKA Victim Sexual Assault Evidence Kit Medical History – Step 1B Page 4 of 4 Rev. Date – Aug/23/2013
Nuclear Bailout: The Costs and Consequences of Renovating the U.S. Nuclear Weapons Complex Executive Summary Despite President Obama’s recent pledge to seek a world free of nuclear weapons, the Department of Energy’s National Nuclear Security Administration (NNSA) is proposing a major upgrade to the nation’s nuclear weapons complex. • If the United States invests in a state-of
Irenísia Torres de Oliveira* Resumo fora escrito, cheia de inquietações e problemas, além das cir- Este artigo apresenta algumas das importantes lei- cunstâncias da publicação, levada a termo na sua ausência. turas críticas do romance Angústia , de Graciliano Ramos, Referia-se a essa impossibilidade de revisão com pesar, pois nos seus setenta anos de publicação, objet