PROTOCOLS AND PROFORMAE FOR MEDICO-

LEGAL EXAMINATION OF SURVIVORS OF

SEXUAL VIOLENCE
&
EVIDENCE COLLECTION KIT

Prepared by NICFS* based on guidelines issued by Ministry

of Health & Family Welfare in 2014
*Lok Nayak Jai Prakash Narayan National Institute of Criminology and Forensic Science, Ministry
of Home Affairs, Government of India, Sector- 3 , Rohini, Delhi 110085
 Contributors
Prof. (Dr.) Anil Aggrawal
Director Professor of Forensic
Medicine, Maulana Azad Medical
College, New Delhi
anil.aggrawal@gmail.com

Prof. (Dr.) Satish K. Verma

Professor, Department of Forensic Medicine,
University College of Medical Sciences and G.T.B.
Hospital, Dilshad Garden, Delhi - 110 095
Vermasatish2003@gmail.com

Dr. Suneeta Mittal

Director & Head, Obstetrics & Gynecology at Fortis Memorial Research Institute
Formerly Professor & Head, Obstetrics & Gynecology, AIIMS and Director in
charge WHO-CCR, AIIMS
Suneeta.mittal@gmail.com

Dr. Pakhee Aggarwal

Consultant O&G at Fortis Healthcare
Formerly Assistant Professor, Lady Hardinge Medical College,
Doctor, MAMC and Senior Resident, O & G, AIIMS
drpakhee@gmail.com

Dr. Vijay Dhankar

Head of Department of Forensic Medicine, Dr BSA
Hospital Rohini, Delhi
vdhankar@gmail.com

Dr. Vinita Gupta

Senior Specialist, Obstetrics & Gynecology
Dr Baba Saheb Ambedkar Hospital & Medical College, Rohini,
Delhi Vinitagupta24@gmail.com
 INSTRUCTIONS FOR DOCTORS
The examining doctor should carefully read the Guidelines for responding to survivors of
sexual violence issued by the MoHFW, and should be well aware of the comprehensive
care to be provided.
1. Informed consent: Doctors shall inform the person being examined about the nature and
purpose of examination and in case of child to the child's parent/guardian/person in whom the child
reposes trust. This information should include:
a. The medico-legal examination is to assist the investigation, arrest and prosecution of those who
committed the sexual offence. This may involve an examination of the mouth, breasts, vagina,
anus and rectum.
b. To assist investigation, forensic evidence may be collected with the consent of the survivor.
This may include removing and isolating clothing, scalp hair, foreign substances from the body,
saliva, pubic hair, samples taken from the vagina, anus, rectum, mouth and collecting a blood
sample.
c. The survivor or in case of child, the parent/guardian/person in whom the child reposes trust, has
the right to refuse either a medico-legal examination or collection of evidence or both, but that
refusal will not be used to deny treatment to survivor after sexual violence.
d. As per the law, the hospital/ examining doctor is required to inform the police about the sexual
offence. However, if the survivor does not wish to participate in the police investigation, it will not
result in denial of treatment for sexual violence. Informed refusal will be documented in such
cases.
2. Per vaginum examination, commonly referred to by lay persons as 'two-finger test', must not be
conducted for establishing an incident of sexual violence and no comment on the size of vaginal
introitus, elasticity of the vagina or hymen or about past sexual experience or habituation to
sexual intercourse should be made as it has no bearing on a case of sexual violence. No
comment on shape, size, and/or elasticity of the anal opening or about previous sexual
experience or habituation to anal intercourse should be made.
3. Injury documentation: Examine the body parts for sexual violence related findings (such as
injuries, bleeding, swelling, tenderness, discharge). This includes both micro mucosal injuries
which may heal within short period to that of severe injuries which would take longer to heal.
Please refer to section VI Point 17 of the Guidelines.
• Injuries must be recorded with details - size, site, shape, colour.
• If a past history of sexual violence is reported, then record relevant findings. Sexual violence is
largely perpetrated against females, but it can also be perpetrated against males, transgender
and intersex persons.
4. The nature of forensic evidence collected will be determined by three main factors- nature of
sexual violence, time lapsed between incident of sexual violence and examination and whether
survivor has bathed or washed herself. Please refer to Section VI Point 21of Guidelines.
5. Opinion: The issue of whether an incident of rape/sexual assault occurred is a legal issue and
not a medical diagnosis. Consequently, doctors should not, on the basis of the medical
examination conclude whether rape/sexual assault had occurred or not. Only findings in relation

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 to medical findings should be recorded in the medical report.
• Drafting of provisional opinion should be done immediately after examination of the survivor on
the basis of history and findings of detailed clinical examination of the survivor.
• It should be always kept in mind that normal examination findings neither refute nor confirm
sexual violence. Hence circumstantial/other evidence may please be taken into consideration.
• Absence of injuries may be due to:
o Inability of survivor to offer resistance to the assailant because of intoxication or threats
o Delay in reporting for examination
6. Medico-legal Examination report should be made in triplicate (One copy original to I.O., one to
victim and one to record)
7. Age Estimation is an important part of victim examination (Refer to page no. 19 and 20)

The following are the components of a comprehensive health care response to sexual violence and must be
carried out in all cases:

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 CONFIDENTIAL

Medico-legal Examination Report of Sexual Violence

1. Name of the Hospital No. .....................OPD No...................Inpatient No...................

2. Name ................................................D/o or S/o (Where Known).................................
3. Address........................................................................................................................
4. Age (as reported)...............................Date of Birth (if Known).....................................
5. Sex (M/F/Others).........................................................................................................
6. Date and Time of arrival in the hospital.......................................................................
7. Date and Time of commencement of examination.......................................................
8. Brought by .................................................................
(Name & signatures)
9. MLC No. ...................................................Police Station............................................
10. Whether conscious, oriented In time and place and person.......................................
11. Any physical/intellectual/psychosocial disability...........................................................
(Interpreters of special educators will be needed where the survivor has special needs
such as hearing/speech disability, language barriers, intellectual or psychosocial
disability.)
12. Informed Consent/refusal
I..............................................................................D/o or S/o...........................................
hereby give my consent for:

a) Medical Examination for Treatment Yes/No

b) This Medico Legal Examination Yes/No
c) Sample Collection for Clinical & Forensic Examination Yes/No

I also understand that as per law the hospital is required to inform police and this has
been explained to me.

I want the information to be revealed to the police Yes/No

I have understood the purpose and the procedure of the examination including the risk and
benefit, explained to me by the examining doctor. My right to refuse the examination at any
stage and the consequence of such refusal, including that my medical treatment will not be
affected by my refusal, has also been explained and may be recorded. Contents of the
above have been explained to me in ......................................language with the help of a
special educator/interpreter/support person (circle as appropriate).....................................

If special educator/interpreter/support person has helped, then his/her name

and signature.....................

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 Name & signature of survivor or parent/Guardian/person in whom the child reposes trust
in case of child (<12yrs)

.........................................................
.........................................................
.........................................................

With Date, Time & Place ………………………………………………………………………………

Name & signature/thumb impression of Witness

......................................................
......................................................
......................................................

Left Thumb Impression

With Date, Time and Place…………………………………………………………………………..

13. Marks of identification ( Any scar/mole)

(1) ...............................................................................
(2)................................................................................

14. Relevant Medical/Surgical history

-Mark the relevant option
 Onset of menarche (in case of girls) Yes / No
 Age of onset........................................
 Menstrual history - Cycle length and duration.......................
 Last Menstrual period..............
 Menstruation at the time of incident - Yes/ No
 Menstruation at the time of examination- Yes/ No
 Was the survivor pregnant at time of incident - Yes/No,
 If yes, duration of pregnancy.........weeks
 Contraception use : Yes/No
 If yes-method used:...............................................
 Vaccination Status –
Tetanus Yes/No
Hepatitis B Yes/No

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15A. History of Sexual Violence

a.

i. Date of incident/s being reported ……………………………………

ii. Time of incident/s ………………………………………
iii. Location/s ………………………………………

ii.Estimated duration: (1-7 days) ........... days

(1 week to 2 months) ............ week/month
(2-6 months) .............months
>6 months .............months/year
iii.Episode: One ..............Multiple...................Chronic (>6 months)............Unknown.............

iv.Number of Assailant (s) and name/s

………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
v. Sex of assailant(s)…………………………………………………………………………………
vi. Approx. Age of assailant (s) ……………………………………………………………..…….
vii. If known to the survivor - relationship with the Survivor..............................................
viii.Description of incident in the words of the narrator :
ix.Narrator of the incident: Survivor/Informant (indicate and specify name and relation to
survivor)

if this space is insufficient use extra page

15B. Type of physical violence used if any (Tick mark the relevant and describe wherever
required):

 Hit with (Hand/ Fist/ Blunt Object/ Sharp Object)…………………………………………

 Burned with……………………………….  Pulling Hair…………………………..

 Biting ……………………………………..  Violent shaking………………………

 Kicking…………………………………….  Banging head………………………..

 Pinching…………………………………..  Dragging……………………………..

 Any other:……………………………………………………………………………………..
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15C.
i. Emotional abuse of violence if any (insulting/ cursing/belittling/terrorizing).............................
ii. Use of restraints, if any................................................................................................................
iii. Used or threatened the use of weapon(s) or objects if any.....................................................
iv. Verbal threats (For Example: Threats of killing or hurting survivor or any other person in
whom the survivor Is interested; Use of photographs for blackmailing, etc.) if any:
............................................................................................................................. ..........
v. Luring (Sweets/Chocolates/Money/Job) if any..........................................................
vi. Any other...................................................................................................................

15D.
i. Any H/O drug/alcohol intoxication………………………………………………………………….
ii. Whether sleeping or unconscious at the time of the incident...............................................

15E. If survivor has left any marks of injury on assailant/s, enter details..........................................

15F. Details regarding sexual violence: Was penetration by penis, fingers or object or other body
parts (Indicate as Y = Yes, N = No, DNK = Do Not Know, EO = Emission Occurred)

Mention and describe body part/s and/or object/s used for penetration.
Accused Penis Object/ Other Manipulation of woman Mouth
Body Part
Victim
Vaginal

Urethral

Anus

Mouth

Oral sex performed by assailant on survivor

Forced Masturbation of self by survivor

Masturbation of Assailant by Survivor,

Forced Manipulation of genitals assailant by survivor

Exhibitionism (perpetrator displaying genitals)

Did ejaculation occur outside body orifice

(vagina/anus/mouth/urethra)?

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If yes, describe where on the body
Kissing, licking or sucking any part of
survivor's body
Touching/Fondling
Condom used*
If Yes status of condom
Lubricant used*
If yes, describe kind of lubricant used
If object used, describe object:
Any other forms of sexual violence

* Explain what condom and lubricant is to the survivor

Yes/No/Do Not know Remarks
Post incident has the survivor
Changed clothes
Changed undergarments
Cleaned/washed clothes
Cleaned/washed undergarments
Bathed
Douched
Passed urine
Passed stools
Rinsing of mouth/Brushing/Vomiting
(Circle any or all as appropriate)

Time since incident...................................................................................................................

H/o Vaginal /anal /oral bleeding/discharge prior to the incident of sexual

violence....................................................................................................................................

H/o vaginal/anal/oral bleeding/discharge since the incident of sexual violence........................

H/o painful urination/ painful defecation/fissures/ abdominal pain/ pain in genitals or any
other part since the incident of sexual violence........................................................................
..................................................................................................................................................

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16. General Physical Examination-
 Is this the first examination…………………………………………….....……………………………
 Pulse………. …………………………… BP…………………………………….…………………….
 Temp.…………………………………….Resp. Rate………………….………………………..........
 Pupils ………………………………………………………………………………….…………….…..
 Any observation in terms of general physical wellbeing of the survivor…….…………………….

17. Systemic examination:

 Central Nervous System: ……………………………………………………………………………..
 Cardio Vascular System: ………………………………………………………………………………
 Respiratory System: ……………………………………………………………………………….......
 Chest: …………………………………………………………………………………………………....
 Abdomen: …………………………………………………………………………………………….....

18. Examination for injuries on the body if any

The pattern of injuries sustained during an incident of sexual violence may show
considerable variation. This may range from complete absence of injuries (more
frequently) to grievous injuries (very rare).
(Look for bruises, physical torture injuries, nail abrasions, teeth bite marks, cuts, lacerations,
fracture, tenderness, any other injury, boils, lesions, discharge specially on the scalp, face,
neck, shoulders, breast, wrists, forearms, medial aspect of upper arms, thighs and buttocks)
Note the Injury type, site, size, shape, colour, swelling signs of healing simple/grievous,
dimensions.)

Scalp examination for areas of tenderness (if hair pulled out/

dragged by hair) / Extraneous Matter
Facial bone injury: orbital blackening, tenderness

Petechial haemorrage in eyes and other places

Lips and Buccal Mucosa / Gums

Behind the ears

Ear drum

Neck, Shoulders and Breast

Upper limb

Inner aspect of upper arms

Inner aspect of thighs

Lower limb and Buttocks

Other, please specify

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Right Left

ANTERIOR VIEW

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Left Right

POSTERIOR VIEW

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19. Samples Collection for Central/ State Forensic Science Laboratory
Clothing evidence, where available – (to be packed in separate paper bags after air drying –
in envelope labeled step 3A and 3B)

List and Details of clothing worn by the survivor at time of incident of sexual violence

20. Collection of Debris/ stains/nails/swabs (In envelope labeled step 4A, 4B, 4C , 4D, 4E and 4F)
Body evidence samples as appropriate (duly labeled and packed separately)
Steps Collected (Y) /Not Collected (N) Reason for not
collecting
4A Head hair combing (Debris)
4B In-between finger (Debris)
4C Swabs from Stains on the body
(blood, semen, foreign
material, others)
4D Nail scrapings (both hands
separately)
4E Nail clippings (both hands
separately)
4F Scalp hair (10-15 strands)

21. Breast Examination (In envelope labeled step 5)

Collected (Y) /Not Collected (N) Reason for not
collecting
Swab from each breast (Two Swabs)

22. Local examination of genital parts/other orifices*:

External Genitalia: Record findings and state NA where not applicable.
Body parts to be examined Findings

Urethral meatus & vestibule

Labia majora

Labia minora
Fourchette & Introitus
Hymen Perineum

External Urethral Meatus

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23. Genital evidence (In envelope labeled step 6A, 6B and 6C)
* Swab sticks for collecting samples should be moistened with distilled water provided.
Steps Collected (Y) /Not Reason for not
Collected (N) collecting
6A Pubic hair combing (mention if
shaved)
6B Cut strands of pubic hair (mention
if shaved)
6C Cut strands of Matted pubic hair

24. Cervical,Vaginal and urethral swabs( In envelope labeled step 7A, 7B, 7C and 7D)
Per/Vaginum /Per Speculum examination should not be done unless required for detection of
injuries or for medical treatment.
Steps Collected (Y) /Not Reason for not
Collected (N) collecting
7A Two Cervical swabs and two slides
(for semen examination and DNA
testing)
7B Two Vaginal swabs and two slides
(for semen examination and DNA
testing)
7C Two Urethral swabs and two slides
(for semen examination and DNA
testing)
7D Any other
(tampon/sanitary
napkin/condom/object)

P/S findings if performed ………………………………………………………………………

P/V findings if performed ………………………………………………………………………
Record reasons if P/V of P/S examination not performed …………………………………………

25. Cervical Swab - Culture for infection (In envelope labeled step 8)

26. Washing from vagina (In envelope labeled Step 9)

Collected (Y) /Not Collected (N) Reason for not collecting
Vaginal washing

27. Anus and Rectum (In envelope labeled step 10A and 10 B)
Bleeding/ tear/ discharge/ oedema/ tenderness (Encircle the relevant)
Steps Collected (Y) Reason for not
/NotCollected (N) collecting
10A Two Anal swabs and two slides
(for semen examination and DNA testing)
10B Two Rectal swabs and two slides
(for semen examination and DNA testing)

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28. Oral Cavity - (In envelope labeled step 11A and 11B)
Bleeding/ discharge/ tear/oedema/ tenderness (encircle the relevant)
Steps Collected (Y) /Not Reason for not
Collected (N) collecting
11A Two Oral swabs and two slides
(for semen examination and DNA testing)
11B One Dental Floss

29. Blood Collection (In envelope labeled step 12A, 12B, 12C and 12D)
Steps Collected (Y) /Not Reason for not
Collected (N) collecting
12A Blood for grouping, testing drug/alcohol
intoxication (plain vial)
12B Blood for alcohol levels (Sodium fluoride vial)
12C Blood for DNA analysis (DNA card and gauge
cloth piece)
12D Blood for HIV, VDRL, HbsAg testing
(EDTA vial)

30. Urine Collection (In envelope labeled step 13A and 13B)
Steps Collected (Y) /Not Reason for not
Collected (N) collecting
13A Urine test for Pregnancy
13B Urine (drug testing)

31. Other relevant tests ordered (indicate the relevant option)

a) Ultrasound for pregnancy/internal injury - Yes/No
b) X-ray for Injury – Yes/No

*Samples to be preserved as directed till handed over to police along with duly attested sample seal.

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32. Treatment prescribed :
Treatment Yes No Type and comments
STI prevention treatment
Emergency contraception
Wound treatment
Tetanus prophylaxis
Hepatitis B vaccination
Post exposure prophylaxis for HIV
Counseling
Other

33. Date and time of completion of examination........................................................

This report contains...............number of sheets and. . . . . . . . . . . number of envelopes.

Signature of Examining Doctor

Name of Examining Doctor

Place Seal

33. Final Opinion (After receiving Lab reports)

Findings in support of the above opinion, taking into account the history , clinical
examination finding and laboratory reports of bearing identification marks described
above…………………….hours/days after the incident of sexual violence, I am of the
opinion that:…………………………………………………………………………………………....
………………………………………………………………………………………………………......
....………………………………………………………………………………………………………..

Signature of Examining Doctor

Name of Examining Doctor

Place Seal

COPY OF THE ENTIRE MEDICAL REPORT MUST BE GIVEN TO THE SURVIVOR/

VICTIM FREE OF COST IMMEDIATELY
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 Checklist of Steps of Medico-legal Examination
Steps No. Details Page = if collected
X = if not collected

Step 1 1 Informed Consent 3-4

Step 2 2 History of Sexual Violence 5-7
Step 3 3A Clothing- Outer 14
3B Clothing- Inner
Step 4 4A Head hair combing (Debris)
4B In-between finger (Debris)
4C Swabs from Stains on the body
(Blood, semen, foreign material,
others) 14
4D Nail scrapings (both hands
separately)
4E Nail clippings (both hands
separately)
4F Scalp hair (10-15 strands)
Step 5 5 Two Breast Swabs 14
Step 6 6A Pubic hair combing
6B Cutting of pubic hair 15
6C Cutting of Matted pubic hair
Step 7 7A Two Cervical swabs and two slides
7B Two Vaginal swabs and two slides 15
7C Two Urethral swab and two slides
7D Any other
Step 8 8 Cervical Swab for Culture 15
Step 9 9 Vaginal washing 15
Step 10 10A Two Anal swabs and two slides 15
10B Two Rectal swabs and two slides
Step 11 11A Two Oral swabs and two slides 16
11B Dental Floss
Step12 12A Blood for grouping, testing
drug/alcohol intoxication
12B Blood for alcohol levels 16
12C Blood for DNA analysis
12D Blood for HIV, VDRL, HbsAg
Step 13 13A Urine test for Pregnancy 16
13B Urine (drug testing)
Step14 14 Medical Examination Report 17

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(1) Thumb impression (Right in female, and left in male)

(2) Any scar/mole/ deformity, etc …………………………..

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 Medico-Legal Evidence Collection Kit in Sexual Offences
CONTENTS
S. No. Matter to be printed on the Description of Content
envelope envelope
1. Step 3A Outer Clothing Thick paper White paper sheet of size 4 x 4 feet
envelope, (35 x
45 cm)
2. Step 3B Inner Clothing Thick paper White paper sheet of size 4 x 4 feet
envelope, (30 x
25 cm)
3. Step 4A - Head Hair Combing WPE* A plastic comb
(For Debris)
4. Step 4B - Debris for In-Between WPE* One sterile cotton swab (150 x 12 mm )in
Finger tube
5. Step 4C for Swabs from Stains WPE* Three sterile cotton swab (150 x 12 mm
On The Body )in tube
6. Step 4D - Nail Scrapings WPE* Pointed forceps, one sterile cotton swab
and distilled water vial
7. Step 4E - Nail Clippings (Both WPE* One nail cutter
Hands Separately)
8. Step 4F - Scalp Hair (10-15 WPE* Small scissor
Strands)
9. Step 5 - Breast Swabs WPE* Two sterile cotton swab (150 x 12 mm )in
tube, pair of microscopic slides with
plastic cover
10. Step 6A - Pubic hair combing WPE* One small plastic comb
11. Step 6B - Cut strands of pubic hair WPE* Small butter paper envelope
12. Step 6C – Cut strands of Matted WPE* Small butter paper envelope
pubic hair
13. Step 7A - Two Cervical swabs and WPE* Two sterile cotton swab (150 x 12 mm )in
two slides tube, pair of microscopic slides with
plastic cover
14. Step 7B - Two Vaginal swabs and WPE* Two sterile cotton swab (150 x 12 mm )in
two slides tube, pair of microscopic slides with
plastic cover
15. Step 7C - Urethral swab and two WPE* Two sterile cotton swab (150 x 12 mm )in
slides tube, pair of microscopic slides with
plastic cover
16. Step 7D - Any other WPE* Butter paper
17. Step 8 - Cervical Swab for Culture WPE* One pack of cervical swab and culture
18. Step 9 - Vaginal washing WPE* One 5ml distilled water and one red
rubber tubing (size 8, approx. 35 cm long)
with syringe
19. Step 10 A – Two Anal swabs and WPE* Two sterile cotton swab (150 x 12 mm )in
two slides tube, pair of microscopic slides with
plastic cover
20. Step 10 B – Two Rectal swabs and WPE* Two sterile cotton swab (150 x 12 mm )in
two slides tube, pair of microscopic slides with
plastic cover
21. Step 11 A – Two Oral swabs and WPE* Two sterile cotton swab (150 x 12 mm )in
two slides tube, pair of microscopic slides with
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 plastic cover
22. Step 11B – Dental Floss WPE* One dental floss with plastic handle
23. Step 12 A – Blood for grouping, WPE* One plain vial and gauge cloth piece
testing drug/alcohol intoxication
24. Step 12 B – Blood for alcohol WPE* One Sodium fluoride vial
levels
25. Step 12 C – Blood for DNA WPE* One DNA card and gauge cloth piece
analysis
26. Step 12 D –Blood for HIV, VDRL, WPE* One EDTA vial
HbsAg testing
27. Step 13A – Urine test for WPE* One pregnancy detection kit
Pregnancy
28. Step 13B – Urine WPE* One sterile plastic container

*White paper envelope (28 x 12 cm. approx.) containing One A4 size white paper
Note: kIt should also contain two pairs of gloves

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