Summary of Attachment 4_Patient Assault Information Form

This is a Patient Assault Information Form attachment related to Maine's Master Agreement for Sexual Assault Evidence Collection Kits. The form serves as a standardized information collection document designed to document details pertaining to patient assault incidents. The form functions as a supporting exhibit to the master agreement and appears to be intended for use by healthcare facilities and law enforcement agencies involved in the evidence collection process. This attachment provides a structured template for recording relevant information about assault cases to ensure consistency and completeness of documentation across participating agencies and jurisdictions within the state.

The form is part of Maine's comprehensive procurement framework for sexual assault evidence collection kits and related services. As a supporting document to the master agreement, it establishes procedural and informational requirements for agencies responding to sexual assault cases. The Patient Assault Information Form enables standardized data collection that supports both immediate investigative needs and long-term statistical and quality assurance purposes across Maine's network of healthcare and law enforcement partners participating in the sexual assault evidence collection program.