THE KENYA POLICE P3
MEDICAL EXAMINATION REPORT
PART 1-(To be completed by the Police Officer Requesting Examination)
From………………………………………………..Ref……………………………
……………………………………………………...Date…………………………..
To the................................................................................................Hospital/Dispensary
I have to request the favour of your examination of:- Name…ALICE……
KARIUKI………………………………………...Age 34...................(If known)
Address………………….............Date and Time of the alleged offence..23/12/24.....
……………………………………………………………………………...
Sent to you/Hospital on the……………………20…..under escort of………………
…........................................and of your furnishing me with a report of the nature and
extent of bodily injury sustained by him/her.
Date and time report to police…
24/12/24…………………………………………………… Brief details of the alleged
offence……ROAD…ACCIDENT…………………………………………
………………………………………………………………………………………
………………………………………… ……………………………………..
Name of Officer Commanding Station Signature of the Officer Commanding Station
PART 11-MEDICAL DETAILS - (To be completed by Medical Officer or Practitioner
carrying out examination)
(Please type four copies from the original manuscript)
SECTION ‘’A’’-THIS SECTION MUST BE COMPLETED IN ALL
EXAMINATIONS
Medical Officer’s Ref.NO………………………………………………………
1. State of clothing including presence of tears, stains (wet or dry) blood, etc.
.BLOOD ON CLOTHES DUE TO IMPACT
……………………………………………………………………………………
....………………………………………………………………………………….
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2. General medical history (including details relevant to offence)……………………
.……………………………………………………………………………………….
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3. Genaral physical examination (including general appearance, use of drugs or
Alcohol and demeanour)
………
NONE…………………………………………………………………………………
This P3 Form is free of charge
SECTION ‘’B’’- TO BE COMPLETED IN ALL CASES OF ASSAULT,
INCLUDING SEXUAL ASSAULTS, AFTER THE
COMPLETION OF SECTION ‘’A’’
1. Details of site, situation, shape and depth of injures sustained:-
a) Head and neck…SKULL…FRACTURE……IMPACT FROM TH E…
COLLISION………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
b) Thorax and Abdomen……
NORMAL……………………………………………………….
……………………………………………………………………………………
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c) Upper limbs………………………………………………………………………
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d) Lower limbs …FRACTURED …
LEGS………………………………………………………………….
………………………………………………………………..............
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2. Approximate age of injuries (hours, days, weeks)……
WEEKS………………………………….
……………………………………………………………………………………………
3. Probable type of weapon(s) causing injury…ROAD……
ACCIDENT…………………………………….
……………………………………………………………………………………….
4. Treatment, if any, received prior to examination……XRAY,…ANALGESIS,…PAIN
KILLERS…AND…STICHES…WITH SURGERY…………………….
..………………………………………………………………………………………
5. What were the immediate clinical results of the injury sustained and the assessed
degree, i.e.’’harm’’, or’ grievous harm’’.*
GRIVEOUS HARM
DEFINITIONS:-
‘’Harm’’ Means any bodily hurt, disease or disorder whether permanent or temporary.
‘’Maim’ means the destruction or permanent disabling of any external or organ, member or sense
‘’Grievous Harm’’ Means any harm which amounts to maim, or endangers life, or seriously or permanently injures
health, or which is likely so to injure health, or which extends to permanent disfigurement, or to any permanent, or
serious injury to external or organ.
…………………………………………………….
Name & Signature of Medical Officer/Practitioner
Date……………………………………………….
This P3 Form is free of charge
SECTION “C”-TO BE COMPLETED IN ALLEGED SEXUAL OFFENCES
AFTER THE COMPLETION OF SECTIONS “A” AND “B”
1. Nature of offence................................................................Estimated age of person
examined……………………………………………………………………………
2. FEMALE COMPLAINANT
a) Describe in detail the physical state of and any injuries to genitalia with
special reference to labia majora, labia minora, vagina, cervix and
conclusion…………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
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b) Note presence of discharge, blood or venereal infection, from genitalia or
on body externally……………………………………………………………
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3. MALE COMPLAINANT
b) Describe in detail the physical state of and any injuries to
genitalia……………………………………………………………………
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c) Describe in detail injuries to anus…………………………………………..
………………………………………………………………………………
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d) Note presence of discharge around anus, or/ on thighs, etc.; whether
recent or of long
standing.........................................................................................
........................................................................................................................
........................................................................................................................
This P3 Form is free of charge
SECTION “D”
4. MALE ACCUSED OF ANY SEXUAL OFFENCE
a) Describe in detail the physical state of and any injuries to genitalia especially
penis……………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………
b) Describe in detail any injuries around anus and whether recent or of long
standing…………………………………………………………………………
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5. Details of specimens or smears collected in examinations 2 ,3 or 4 of section “C”
including pubic hairs and vaginal
hairs………………………………………….....................................................................
.……………………………………………………………………………………………
…………………………………………………………………………………………….
6. Any additional remarks by the doctor…………………………………………………....
……………………………………………………………………………………………
…..………………………………………………………………………………………..
……………………………………………………………………………………………
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Name & Signature of Medical Officer/Practitioner
Date………………………………………………….
This P3 Form is free of charge
