This customizable document, Domestic Violence Assessment and Reporting, is taken from MCN Healthcare's Administrative Manual for Ambulatory Care Facilities. For more than 20 years, MCN has been the health care industry's leading provider of policy and procedure templates, forms, competencies and other compliance tools.

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Here is some sample content from Domestic Violence Assessment and Reporting:

	PURPOSE: To provide guidelines for assessing and interviewing suspected victims of domestic abuse. All facility staff may perform and may be responsible. POLICY: Facility, in accordance with the state Domestic Violence Reporting Law, will assess patients who exhibit signs of spousal or partner abuse and, when appropriate, make an oral and written report. PROCEDURE: Responsibility: Any health practitioner employed in a health facility or clinic who has knowledge of or observes a patient whom he/she suspects has suffered an injury as the result of an abusive relationship, must report this...
Second excerpt:
	...prosecution. Facilitate communications with agencies that victim has specified a desire to interact with and advocate on his/her behalf i.e., finding available shelter beds. Utilize local law enforcement, as necessary, for safe transport of victim to shelter or family/friend's home. If patient is to be hospitalized, arrange for continued attention to his/her psychosocial needs and safety concerns while hospitalized. Coordinate appropriate referrals, including legal counseling and law...