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Anonymous Kit Consent Form.pdf

937bb3_6858afd9ae974fc89ca580b3ad8f221a.pdf
Preview of Anonymous Kit Consent Form
🔗 Source: saneofbutlercounty.org
📊 Size: 139 KB
📄 Pages: 2 pages
⬇️ Downloads: 101

Summary

I understand that I will not be charged for the antibiotics and evidence collection exam, but other medical treatments will be billed to me or my insurance. I can have a support person with me during the exam and may decline any portion of it. I consent to the medical forensic exam, evidence collection, and photo documentation, including genital photos. The hospital must report sexual assaults to law enforcement, and evidence kits may be tested or destroyed. I can request that my name and identifying information not be released to law enforcement. I understand that anonymous patients are not eligible for Victims of Crime compensation and that my medical records may be subpoenaed by the court.

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Description

I understand that I will not be charged for the antibiotics and evidence collection exam, but other medical treatments will be billed to me or my insurance.

Technical Information

  • File Format: PDF
  • File Size: 139 KB
  • Pages: 2
  • Language: EN
  • Total Downloads: 101
  • Last Updated: 1 week ago

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This PDF document about Anonymous Kit Consent Form provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into Anonymous Kit Consent Form.

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