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Reimbursement for Forensic Medical Examination (FME)

The victim of a sexual assault/rape is not responsible for the costs associated with the sexual assault (rape) examination, to collect and preserve evidence of the crime. The Attorney General’s office provides reimbursement directly to the hospital or clinic where the examination is performed. The flat fee reimbursement is considered full payment of all expenses related to the examination, including the cost of antibiotics and other medications administered as part of the examination.

The victim is responsible, however, for the costs of additional care that is not for the collection of evidence, such as X-rays, stitches, hospitalization, pain medication or counseling. The victim may be eligible to have these additional costs paid by the North Dakota Crime Victims Compensation Fund if she reports the crime within 72 hours and cooperates with law enforcement.

  • A medical provider may request an additional amount for reimbursement of Emergency Medical Treatment & Labor Act (EMTALA) screening;
  • Reimbursement has been extended to include non-acute examinations performed on child victims of alleged criminal sexual conduct (such as allegations of ongoing sexual abuse of a child);

FME Reimbursement Request Form

  • The FME Reimbursement Request form has been revised to reflect these changes. The new form is a 1-page triplicate form which contains a unique pre-printed number on the top right-hand side. The medical provider retains the PINK copy to track the reimbursement request and payment and submits the white and yellow copy to the Crime Laboratory (along with the required supporting documentation). The unique number on the top of the form is printed on the reimbursement check issued by this office so the medical provider can credit the payment against the corresponding request form. Instructions for proper completion and mailing are printed on the reverse of the triplicate form. The FME Reimbursement form is submitted for reimbursement independent of the rape kit. Do NOT include the completed reimbursement form with the rape kit.

Forensic Medical Examinations New Coverage, New Reimbursement Request Forms - PDF
Medical Provider FAQ's - PDF
Patient Information - PDF
Sexual Assault Forensic Examination Procedures (Chart Summary) - PDF
Sexual Assault Examination Kit - Appendix C Form PDF