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Proforma Age Estimation PDF

1. This document is a forensic medical examination report used to estimate the age of a male or female patient. 2. It records preliminary information about the patient including name, age, address, and reason for examination. 3. The patient consents to examination of their genitals, secondary sexual characteristics, dental examination, radiological examination, and use of the report for legal and research purposes. 4. Physical examinations of secondary sexual characteristics and dental examinations are performed. Radiological examinations may also be done. 5. Based on the examinations, the doctor provides an opinion on the estimated age range of the patient.

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472 views3 pages

Proforma Age Estimation PDF

1. This document is a forensic medical examination report used to estimate the age of a male or female patient. 2. It records preliminary information about the patient including name, age, address, and reason for examination. 3. The patient consents to examination of their genitals, secondary sexual characteristics, dental examination, radiological examination, and use of the report for legal and research purposes. 4. Physical examinations of secondary sexual characteristics and dental examinations are performed. Radiological examinations may also be done. 5. Based on the examinations, the doctor provides an opinion on the estimated age range of the patient.

Uploaded by

Yogita
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORENSIC MEDICAL EXAMINATION REPORT OF AGE ESTIMATION

(MALE / FEMALE)

(I) Preliminary information and consent


1. Name of the hospital:- ……………………………………………………
2. OPD/IPD No.:-………………..Date:-………………….MLC No.:-………………..Date:-…………….
3. Name of the Patient:-……………………………………………….
4. Age:-………(As informed by patient);Date of Birth:-……………Religion:…………………….
5. Married/Single/Divorced:-…………………………………………………..
6. Address:-…………………………………………………………………….
7. Brought by:-……………………….of………………………….Police Station.
C.R.No………………………U/s………………………..

8. CONSENT:-
I …………………………………………………..here by voluntarily consent and agree to the following-

a) Medical examination and examination of genitals and also examination of other secondary
sexual characters for the purpose of age estimation.

b) Radiological and dental examination for the purpose of age estimation.

c) Photography for the purpose of criminal investigation if required.

d) The report may be used for legal evidence, clinical audit, research and academic purposes.

e)* Inform the police and provide them the copy of this examination.

f) *I have also been informed that I can refuse the examination at any stage and also refuse
information to be given to the police. In this event I understand that I will be responsible for any
problem arising in the process of crime investigation and court trial.

g) All this has been explained to me in my mother tongue i.e…………………………………………………….


language /………………………………………………………….language which I can understand.

( * Strike out e) and f) in case of male patients as it is not applicable to them due to the provisions
of section 53 of the code of Criminal procedure)
Signature &name &contact no Signature & name of the person

Of the witness or guardian in case of minor & below 12 years

e) Signature and name of female nurse/attendant…………………………………………………………………………….

In presence of whom examination is conducted..,………………………………………………………………………….

f) Identification: 1………………………………………………………………………………………………………………………………

Marks 2……………………………………………………………………………………………………………………………….

g) Right hand thumb impression in case of Females &

Left hand thumb impression in case of Males

General Physical Examination


Height: ………… Weight:…………….Built:………………Nutrition:…………….
Pulse:……………B.P:…………………
Secondary sexual characters
MALE FEMALE
Moustaches Breast Development
Beard Genitals
Pubic Hairs Pubic Hairs
Axillary Hairs Axillary Hair
Voice, Adams apple Menarche
External Genitalia LMP

Dental Examination
RIGHT LEFT

a) Total Nos.---------------------------- b) Spacing behind 2nd Molar………………………


c) Any abnormality :----------------------------------------------------------------------------------
Radiological Examination
X Ray Advised X Ray Plate no & Observations
Date

OPINION REGARDING AGE


After performing general, physical, dental and radiological examination, I am of the considered

opinion that age of this person is between ……………………………and ………………………with a range

of (plus/minus) margin of error of …………………. months/years.

Date:-……………..Place:-…………………… Signature
Name
Stamp / Seal
Of Designation
And Hospital

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