responsibility of health care providers—medical care for sexual assault patients and collection of evidence from them. It seeks to assist health care personnel in validating and addressing patients’ health concerns, minimizing the trauma patients may experience, promoting healing, and maximizing the collection and preservation of evidence from patients, including documentation of findings, for potential use in the legal system. (A sexual assault medical forensic examination as described in this document addresses both medical and evidentiary needs of the patient following sexual assault). This protocol also addresses the role of advocates, law enforcement representatives, prosecutors, forensic scientists, and other responders in the medical forensic exam process. For various reasons (such as fear, stigma, lack of information, lack of access, or mental trauma), many sexual assault victims choose not to seek medical care or have evidence collected. However, coordination among professionals involved in immediate response may be instrumental in reversing this trend. It is often found that victims will seek assistance when responders work together to ensure that victims are informed of their options for assistance, encouraged to address their needs, have their spiritual and psychological needs respected, and are aided in obtaining the help they want. In addition, multidisciplinary coordination has proven to enhance medical care provided to victims as well as evidence collection and preservation efforts.13 Background This national protocol was developed by the Office on Violence Against Women (OVW) under the direction of the Attorney General pursuant to the Violence Against Women Act of 2000.14 In developing the protocol, OVW reviewed existing protocols on sexual assault forensic examinations and consulted with national, state, local, and tribal experts on sexual assault. Experts were consulted from rape crisis centers; state and tribal sexual assault and domestic violence coalitions and programs; and programs for criminal justice, forensic 12 STI are also commonly known as sexually transmitted diseases (STDs). 13 For example, when first responders explain to victims how to preserve evidence on their bodies and clothing prior to arrival at the exam site, they may increase the likelihood that the evidence will be collected rather than contaminated or destroyed. 14 The statutory requirement to develop this protocol can be found in Section 1405 of the Violence Against Women Act of 2000, Public Law 106-386. The statutory requirement also mandates the development of a national recommended standard for training for health care professionals performing these examinations, as well as related training for all health care students. These training standards were released in June, 2006 and are available at http://www.dna.gov/. 13 nursing, forensic science, emergency medicine, law, social services, and sex crimes in underserved communities.15 Starting in the summer of 2001, the Department of Justice (DOJ) began gathering information on resources, issues, and gaps related to sexual assault medical forensic exams. The first task was to identify and obtain relevant materials and data. Existing national and jurisdictional protocols on the exam and immediate multidisciplinary responses to sexual assault were sought,16 as well as documents that analyzed jurisdictional response. Input was solicited on issues, gaps, and promising practices from numerous organizations, associations, and individuals representing disciplines involved in the response to sexual assault. In addition, numerous persons were contacted who could offer perspectives on particular issues related to the exam process. State sexual assault coalitions and state government agencies that oversee violence against women programs, as well as tribal coalitions, were also contacted to gain information on their activities concerning protocol development and training. In some states, data was obtained through discussions with sexual assault forensic examiners and coordinators of examiner programs or sexual assault response teams. A series of forums was held in the summer and fall of 2002, calling upon practitioners and policymakers involved in victim advocacy, health care, forensic science, and criminal justice fields to assist in developing a national protocol. After a draft protocol for adult and adolescent victims was developed in early 2003, it was distributed to a wide array of individuals and organizations for their review and feedback. 17 Comments were first solicited from the individuals who were invited to the forums. Then input was sought from sexual assault survivors, as well as tribal sexual assault and domestic violence coalitions and local advocacy programs. Members of the National Advisory Committee on Violence Against Women also reviewed the draft and provided input. After several revisions of the document, feedback was solicited during the summer of 2003 from many national and state organizations and some local agencies that deal with sexual assault issues or serve diverse populations, as well as other individuals representing relevant disciplines. Comments received were incorporated into the document where appropriate. Many of the revisions from the original protocol are based on recommendations made by the consulted