Schedule 16 (Relating to sub-section (1) of Section 22) Injury Examination Report (It is used in case of examination of detainee also)

Schedule 16

(Relating to sub-section (1) of Section 22)

Injury Examination Report

(It is used in case of examination of a detainee also)

1) Case registration number:

2) Name of the office referred for injury examination (with letter ref. No. and Date):

3) Name, age, date of birth and sex of the injured person:

4) Address:

5) Name of the accompanying police personnel:

6) Name of the Hospital/Health Center:

7) Date, time and place of examination:

8) Identification mark of the examinee:

9) Consent for examination taken from:

Injured person   Family member or others

10) Brief history about the incident (how and when the injuries were produced?)

11) Medical history of the examinee:

12) General physique and vitals:

Height:             Weight                        Pulse        B.P:

Temperature     Respiratory Rate

Degree of consciousness

13) Injuries (name, size, site, color, surrounding area, signs of treatment, bleeding, marks, signs of healings, any imprints and content etc.):

A. Type of injury:

a. Simple:

b. Grievous:

c. Severe:

d. Other remarks:

B. Type of weapon/object used:

a. Blunt force

b.Sharp force

c. Pointed objects

d. Projectile

e. Heat

f. Chemical

g. Others (specify)

C. Condition of the patient at the time of examination:

D. Severity (explain the severity in terms of existing condition and possible complication):

E. Investigation and reports (for example X-ray, USG, Blood, Urine etc.):

F. Treatment provided (briefly):

G. Referral (Where and Why?):

H. Follow up (if necessary):

I. Re-examination (whether case needs information about grade of disability:

Opinion: (Condition of examinee, severity of the injury, age of the injury and possible causative objects should be considered to frame opinion)

Name of the Examiner:

Signature:

Qualification: MC/NHPC

Reg. No.:

Office/Hospital/Health Center:

Date:

Seal of the Hospital/Health Center:

Note bene:

1) Injury examination shall be conducted by a forensic expert, to the extent possible, and by a trained doctor if such expert is not available.

2) The report shall be prepared by the injury examination conducting expert or doctor himself or herself.

3) The report shall be computer typed to the extent possible, if not so, be prepared in a legible manner. In addition, the original of the autopsy report shall be attached.

4) If the specified space is not enough to contain the details, details shall also be set down in a separate sheet as well.