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DOMESTIC VIOLENCE SCREENING P R O T O C O L F O R M E D I AT O R S O F D O M E S T I C R E L AT I O N S C O N F L I C TS PROVIDED BY: Office of Dispute Resolution State Court Administrative Office Michigan
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How to fill out domestic violence screening

01
To fill out the domestic violence screening, follow these steps:
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Start by obtaining the necessary screening form or questionnaire.
03
Ensure you have a quiet and private space where you can comfortably complete the screening.
04
Carefully read each question on the screening form and understand what it is asking.
05
Reflect on your personal experiences and answer each question truthfully and to the best of your ability.
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If you have any doubts or concerns about a particular question, seek clarification from a healthcare professional or counselor.
07
Provide accurate and honest responses without withholding any relevant information.
08
Take your time to complete the screening thoroughly, considering all aspects of your situation.
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Once you have finished filling out the screening, review your answers to ensure they accurately represent your experiences.
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If required, sign and date the screening form as instructed.
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Submit the completed screening form to the designated healthcare provider or organization as directed.

Who needs domestic violence screening?

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Domestic violence screening is recommended for individuals who may be at risk or have a history of experiencing domestic violence.
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This includes but is not limited to:
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- People who have been or currently are in an abusive relationship or domestic partnership.
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- Individuals who have witnessed or experienced violence at home.
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- Those who are concerned about their safety within their intimate relationships.
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- Victims or survivors of physical, emotional, or sexual abuse.
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- Adults and children who are exposed to domestic violence in their household.
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While the need for domestic violence screening may vary based on individual circumstances, it is an important tool for identifying and addressing cases of domestic violence.
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Domestic violence screening is a process of assessing individuals for signs of domestic abuse or violence.
Individuals in certain professions, such as healthcare providers, social workers, and law enforcement officers, may be required to file domestic violence screening forms.
Domestic violence screening forms typically require information such as the individual's name, contact information, relationship status, and any history of domestic abuse.
The purpose of domestic violence screening is to identify individuals who may be at risk of or experiencing domestic abuse, and to provide appropriate support and intervention.
Information such as the presence of physical injuries, emotional distress, incidents of abuse, and any threats of harm should be reported on domestic violence screening forms.
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