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Reimbursement for Forensic Medical Examination

Beginning July 1, 2007, a victim of sexual assault/rape will no longer be responsible for the cost of the sexual assault medical examination to gather evidence for a possible prosecution. A new law authorizes the Attorney General to provide reimbursement directly to the hospital or clinic where the examination is performed.

Note: The reimbursement form should be completed and signed at the time of the examination. The reimbursement form opens as a two-page pdf file. Page 1 is the form, page 2 the instructions. We recommend that medical providers print several copies of the form and instructions and keep them with the Sexual Assault Evidence Collection Kits.

Reimbursement Form (with Instructions) - PDF
Reimbursement Form Additional Information/Instructions - PDF
Medical Provider FAQ's - PDF
Patient Information - PDF
Sexual Assault Forensic Examination Procedures (Chart Summary) - PDF
North Dakota Sexual Assault Evidence Collection Protocol (May 2005) - PDF
Sexual Assuult Examination Kit - Appendix C Form PDF