Rape Case

PROFORMA FOR EXAMINATION OF ALLEGED RAPE CASE (FEMALE-Victim)

PROFORMA FOR EXAMINATION OF ALLEGED RAPE CASE (FEMALE)

Requisition from______________________of Police Station _________________

vide his letter No.__________________________Dated_________________

Name (In full) ___________________________________________

Age as assessed____________Sex__________________M.L.C. No._____

Occupation__________________________Address________________________

Date of Examination____________ Time of Examination_____________________

Alleged time of offence _______AM/PM_________________ Married/Unmarried

Brought by____________________________________

Consent for examination – Victim_____________________________________

Guardian _____________________________________

Identification Marks (1)________________________________________

(2) _____________________________________

History/Detailed account of occurrences as given by woman, especially about the following :

a) Date, Time & Place of Occurrence__________________________
b) Exact position of parties_____________________________________

c) Did she struggle or cry for help? ___________________
d) Was she conscious all the time?____________________ _
e) Did she urinate or defecate after the act ?___________________
Pain?____________
f) Date and time of lodging the complaint_________________
Explain delay_________________________

Enclosure 5 (Refers to Para 20 b xii)

Menstrual History:_________________________________________ ______

M.C.___________________________________–Regular/Irregular
L.M.P.______________________________

Age at Menarche_______________________________

Whether bath was taken Yes/No___________________________When_________

Whether clothes are changed. Yes/No____________________________

Any other relevant information :

Physical Examination

General behavior :

Gait

1) Height (cms) _____________________Weight _______________Kgs

2) General build________________________________

3) Condition of teeth (broken etc)___________________________________

4) Abrasions, bite marks etc over the body (Face, Back of Shoulders, Arms and Thighs) ____________________________________________________

5) Breast, Developed/Not Developed________________________________

6) Secondary Sexual characters Fully developed/Not developed.________

7) Examination of clothes: Presence of tears on clothes
Presence of Mud/Blood/Seminal stains.

8) Matting of public Hairs due to semen: Present/Absent
(Public Hairs to be cut & preserved for examination)_________________

9) Presence of Blood or Seminal Stains on the genitals : Present/Absent (Stains to be preserved on saline swabs for examination)________________

10) Examination of Genitals:

Development of Genital organs : Developed/Not Developed____________
Vulva .____________________Vagina______________________
Perineum______________________ Forchette____________________
P/S Examination_______________________________________________

P/V Examination___________________________

11) Swabs for examination:

a) Vaginal swabs

i. Vulval ____________ ii

Low Vaginal____________

iii. High Vaginal_______________________

b) Urethral Smear for Gonococci_____________________

12) Venereal diseases if any, __________________________

13) Blood Group examination if there is bleeding injury___________

14) Nails__________________________

Signature/Thumb impression of person examined.

OPINION:

Date :
Place:

Signature of the Medical Officer

Name Degree

Designation Reg No.

To,
The Police Sub Inspector,
Police Station

NOTE:

a) When the age is disputed, as has to be determined as per proforma for age estimation.

b) Specimen to be Preserved for examination:

1) Public Hairs

2) Blood & Urine

3) Blood Stain

4)Clothes for exam of stains

5) Vaginal smear/Swab

6) Nails

7) Head hair

8) Bite mark swabs.


Categories: Rape Case

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