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SEXUAL ASSAULT HISTORY FORM NEW MEXICO SEXUAL ASSAULT EVIDENCE KIT (SEEK) Patient Intake Patient Name: Gender: MF Exam Date: Transgender DOB:Ethnicity: Native Am. Hispanic African Am.LMP: Asian White
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Start by carefully reading and understanding the instructions provided on the form. Make sure you have all the necessary information and documents required to complete the form accurately.
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Begin by providing personal details such as your full name, date of birth, contact information, and any other relevant identification details.
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Follow the instructions to provide information about any previous incidents or experiences of sexual assault that you have experienced. Be honest and provide as many details as possible, including dates, locations, and any individuals involved if known.
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Individuals who have experienced sexual assault or want to report a past incident may need to fill out a sex assault history form.
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Healthcare professionals, counselors, or therapists may also ask their clients to fill out a sex assault history form as part of their assessment or treatment process.
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Sex assault history form is a document that collects information regarding any past instances of sexual assault or harassment experienced by an individual.
Anyone who has experienced sexual assault or harassment is encouraged to file the sex assault history form.
To fill out the sex assault history form, individuals need to provide details of any past instances of sexual assault or harassment they have experienced. This may include the date, location, description of the incident, and any other relevant information.
The purpose of the sex assault history form is to collect data on sexual assault and harassment cases to better understand the prevalence of these incidents and to provide support and resources to survivors.
On the sex assault history form, individuals are typically required to report the date of the incident, the location where it occurred, a detailed description of the assault or harassment, and any other pertinent information they feel comfortable sharing.
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