SANE exam records: the sexual assault forensic exam, page by page

A SANE exam is the common name for a sexual assault medical forensic examination. SANE stands for sexual assault nurse examiner: a registered nurse or advanced practice nurse with specialized education and clinical preparation in this exam. The DOJ protocol uses the wider terms "medical forensic examiner" and "clinician," because the exam can also be done by physicians and physician assistants.

The exam has 2 purposes that run side by side. It is medical care: injuries are assessed and treated, and the patient is offered emergency contraception, prophylaxis for sexually transmitted infections and HIV, and follow-up. It is also forensic: a history is taken, findings are documented, photographs may be taken and samples may be collected into a sexual assault evidence collection kit. Federal regulations quoted in the protocol (28 CFR 90.13) set the minimum content of a forensic medical exam: a forensic medical history, a head to toe exam, documentation of biological and physical findings, and collection of physical evidence.

Certification: SANE-A, SANE-P and state credentials

The protocol states the certification position plainly, and every deposition outline on examiner qualifications should start from it:

"National certification (SANE-A) exists for registered and advanced practice nurses through the International Association of Forensic Nurses. It is not required to practice as a sexual assault nurse examiner. There is no equivalent certification for physicians or physician assistants."

SANE-A covers adult and adolescent patients, and SANE-P covers pediatric patients; the DOJ pediatric protocol confirms that pediatric examiner certification through the IAFN is open to registered and advanced practice nurses trained as SANEs. Both credentials changed hands in 2026: on April 3, 2026, the American Nurses Credentialing Center (ANCC) announced an agreement to take over SANE-A and SANE-P from the IAFN ahead of the IAFN's dissolution, and extended credentials due to expire in 2026 through December 31, 2027 (ANCC announcement). For an exam before that date, expect the IAFN as the issuing body. Some states run their own examiner certification through a board of nursing or the attorney general's office. So a nurse can be a trained, practicing SANE without holding SANE-A, and the absence of the credential is not, by itself, a defect in the exam.

Our view: both sides should ask for the examiner's CV and training record early, and compare it to the state's own requirements on the exam date, not today. Which course, how many supervised exams, which credential, current or lapsed, and which protocol version did the program follow that year.

The National Protocol: edition, scope and weight

The DOJ Office on Violence Against Women published the first edition of the National Protocol in 2004. The 3rd edition came out in September 2024 and reflects the reauthorizations of the Violence Against Women Act (VAWA), the most recent in 2022. It covers adults and adolescents; pediatric exams are left to a separate National Protocol for Sexual Abuse Medical Forensic Examinations, Pediatric, published in April 2016.

The protocol is guidance, not a statute. It is written for jurisdictions to adapt (Appendix A is titled "Developing Customized Protocols: Considerations for Jurisdictions"), so most exams follow a state or program protocol built on it. That matters in court in a specific way: the national document shows the accepted practice, and the local protocol shows what this examiner was trained and expected to do. Request both, in the versions in force on the exam date.

The protocol also defines the examiner's role in words both sides quote:

"their role requires them to be objective healthcare professionals, and not an arm of the investigation, nor victim advocates."

SANE

Sexual assault nurse examiner. A nurse trained to perform the medical forensic exam.

SART

Sexual assault response team: the local group of examiners, advocates, law enforcement, prosecutors and lab staff who coordinate the response.

SAK

Sexual assault evidence collection kit. The protocol's abbreviation; also called a rape kit.

MSE

Medical screening exam in the emergency department, which may happen before the forensic exam starts.

DFSA

Drug-facilitated sexual assault. Triggers the toxicology questions and sample windows in chapter 5.

PEP

HIV post-exposure prophylaxis, started within 72 hours of exposure.

Anatomical inventory

A patient-led list of which body parts the patient has, in their own words, used before the exam (protocol Appendix B).

Restricted reporting

A military option that lets a service member get care and advocacy without command notification or an investigation.

Consent in a SANE exam is not 1 signature at the top of a form. The protocol treats it as a process that runs through the whole encounter, with 2 layers: consent to medical evaluation and treatment, and consent to the collection of samples for the kit. The core rule:

"Obtaining informed consent for the medical forensic examination is a flexible and ongoing process; the patient may decline any portion of the examination."

The patient can also withdraw consent at any point, and clinicians are told to keep asking verbally as the exam moves along, even after a written consent is signed. The protocol adds that care "is not predicated upon cooperating with law enforcement or having samples collected" for the kit. A patient can accept treatment and decline the kit, accept the kit and decline photographs, or stop halfway.

The consent items the protocol lists

The protocol lists what patients should be asked to consent to. A reviewer can turn the list into a completeness check: for each item, the record should show offered, accepted or declined, and by whom.

Consent versus authorization

The protocol draws a line many readers miss. Consent covers what happens in the exam room. Release of the record to anyone who is not a health care provider needs a written HIPAA authorization that meets 45 CFR 164.508(b)(1). In the protocol's words, "written authorization is required to release the medical forensic examination record to law enforcement, crime labs, prosecutors and any entities who are not health care providers," unless another legal exception applies. A consent box ticked for "release to law enforcement" on the exam form may or may not meet the authorization rule. Check the form against 45 CFR 164.508 before either side relies on it.

Capacity, intoxication and minors

If a patient cannot consent, the clinician may monitor them until they can. The protocol is explicit that "no specific blood alcohol level is recommended at which an individual is considered able to consent." A blood alcohol number in the chart does not settle capacity to consent to the exam, and neither side should argue that it does. For minors, who may consent and when a guardian must be involved is set by state law, and the protocol asks clinicians to get the minor's assent even when a third party consents. For the medical records side of consent generally, see our guide to informed consent in medical records.

2 federal rules shape who pays for the exam and whether a patient must involve the police to get it. Both show up in the billing file and on the reporting-options form, and both are often misunderstood.

34 USC 10449: rape exam payments

Under the VAWA rape exam payment statute, a state, tribal government or local government is not entitled to certain federal grant funds unless it "incurs the full out-of-pocket cost of forensic medical exams" for victims of sexual assault. It meets that rule if a government entity provides the exams free of charge or arranges for victims to get them free of charge. Grant funds may not pay for exams in a jurisdiction that makes victims seek reimbursement from their insurance carriers. And the condition that settles the police question:

"To be in compliance with this section, a State, Indian tribal government, or unit of local government shall comply with subsection (b) without regard to whether the victim participates in the criminal justice system or cooperates with law enforcement."

The protocol adds the detail that matters for billing records. Under the STOP grant program, states certify each year that they meet this rule, and "full out-of-pocket cost" means any expense that may be charged to a victim in connection with the exam for gathering evidence, including a copayment or deductible where the state has patients submit the charges to insurance. States are not required to pay for all medical care, only the forensic exam.

The federal Survivors' Rights statute, which applies to federal cases, puts the same idea as a right: "The right not to be prevented from, or charged for, receiving a medical forensic examination" (18 USC 3772(a)(1)). The protocol applies the payment rule to incarcerated and detained patients too.

Reporting options and what they do to the file

Many jurisdictions let a patient have the exam and decide later whether to report. The protocol describes practices known as "blind reporting" or "Jane Doe reporting," where a victim can report without identifying themselves, and the military's restricted reporting, which lets service members get care and advocacy without command notification. For a record reviewer, this changes the file in predictable ways: the kit may carry a number instead of a name, the release authorization may be missing because none was signed, and the police report, if any, may be dated weeks or months after the exam. None of those, alone, signals a problem.

For civil damages work, our advice: separate the forensic exam charge from the medical charges in the bills before anyone totals them, and note which payer covered each. The payer for the forensic part is usually a state program, and mixing the 2 overstates or understates what the patient actually owes.

The protocol says what the documentation must include: the medical forensic history, "narrative descriptions of findings, corresponding body maps, a clear delineation of the samples collected, medications administered, and a discharge plan," plus clearly documented consent and authorization for treatment, sample collection, photography and release. Programs use their own forms, and military treatment facilities add Department of Defense form DD 2911, the standard form for every sexual assault evidence kit.

The history is not an interview

The medical forensic history guides the exam: what to look for, where to swab, which treatment to offer. The protocol distinguishes it from an investigative interview. It covers health history, the assault-related history needed for care and sample collection, recent consensual sexual activity (so that a partner's DNA can be identified and used for elimination), and post-assault activities. It also records the patient's statements and demeanor according to jurisdictional policy.

2 points follow for reviewers. First, the history is short and focused by design, so comparing it word for word with a later police interview and calling every difference an inconsistency misreads its purpose. Second, the protocol also tells clinicians to modify the exam to the patient's report: a patient who reports only an oral assault "does not require a speculum examination" simply because it is part of a complete exam. A skipped step can be correct practice.

Photographs and the photo log

Photography needs its own consent. The protocol names 12 megapixels as the minimum camera resolution, asks for at least 2 photographs of each area (with and without a scale) plus orientation shots that show where on the body an injury sits, and provides a sample photograph log in Appendix C. Many programs avoid facial identification images and instead photograph the patient's label at the start and end of the series to "bookend" it. Copies of anogenital photographs generally should not go to anyone but the patient without a subpoena or a signed release, per the protocol.

Also note what the protocol says should not exist: "Audio and video recording of patient medical forensic examinations, including medical forensic histories should not occur." If a request for "all recordings" comes back empty, that is the expected answer.

Where the record lives

The protocol lets facilities store the medical forensic record separately from the main medical record, or inside it with an added layer of protection, such as a break-the-glass rule that limits who can open it and generates an access audit trail. It says there is "no single standardized federal record retention schedule" and that retention policies should be set with statutes of limitation in mind. Practical result: the emergency department chart, the SANE record, the photographs and the kit tracking record may sit in 3 or 4 places under different custodians. A request to "medical records" often returns only the first.

• Emergency department chart for the same visitTriage, screening exam and any treatment before the SANE arrived
• Full medical forensic recordEvery page of the encounter, including forms that look administrative
• Consent and authorization formsEach item offered, accepted or declined, signed and timed
• Body maps with the narrativeMap marks and narrative entries should match 1 to 1
• Photograph logFrame count, areas, scale use; the photos themselves under a protective order
• Kit inventory and seal recordItems collected, seal time, examiner initials
• Chain of custody formsEvery hand-off from collection to the lab and storage
• Toxicology collection and resultsCollection time against the 120 and 24 hour windows
• Medication administration recordEC, STI prophylaxis, PEP start time and prescription
• Discharge instructions and follow-up planWhat the patient was told and given
• Follow-up contactsCalls and visits after the exam, often filed separately
• Program protocol in force on the exam dateThe yardstick for what this examiner was expected to do

0 of 12 checked

Time drives both the medicine and the evidence. The protocol says samples should be collected from any consenting patient "as soon as possible" and up to 5 days or longer after the assault, regardless of what the patient did afterward. Toxicology and 2 medications run on their own clocks, and blood toxicology and HIV PEP run shorter.

All 5 figures are from the DOJ National Protocol, 3rd edition. The toxicology windows matter for the drug-facilitated cases covered in our toxicology report guide: a negative result from a sample collected outside its window says little about what was in the patient's system at the time of the assault.

Packaging and storage

Dry evidence goes in paper, not plastic, because "plastic containers retain moisture and promote degradation of biological evidence." Dry evidence is kept in a locked cabinet and should not be refrigerated. Liquids such as blood and urine must be refrigerated, in a locked refrigerator with limited access. The protocol says only "a law enforcement official or duly authorized agent" should move evidence from the exam site to the lab or storage, and that clinicians should not transport toxicology samples themselves. It quotes the National Best Practices for Sexual Assault Kits: if law enforcement cannot retrieve the evidence within 3 days of collection, it should be shipped with a tracking system that records locations, dates, times and signatures.

What a chain of custody record must show

"A properly documented chain of custody identifies all persons who have had custody of the evidence and tracks the location of that evidence in chronological order from collection to destruction. The collection of samples for the SAK often establishes the first link in the chain of custody."

The protocol lists the fields a tracking record should carry: the collector's identity with date and time; who possessed the evidence in transport; who submitted it and who received it; any release and return; a unique item identification and description; a unique number such as a scannable barcode; and the storage location down to the shelf or bin, with who stored it. A reviewer's job is to walk the log row by row and ask 3 questions of each hand-off: who, when, and does the item count still match.

A prosecutor who finds the gap first can get the refrigerator log, the transport record or a witness to close it before trial. A defense attorney who finds it first has a legitimate authentication question. The gap may have a mundane explanation, such as a separate toxicology courier form, or it may not. For either side, the worst outcome is finding it in front of the jury.

How long the kit is kept

In federal cases, 18 USC 3772 gives survivors the right to have the kit or its probative contents preserved without charge "for the duration of the maximum applicable statute of limitations or 20 years, whichever is shorter," to be told in writing of the policies that govern it, and, on written request, to get written notice not later than 60 days before its intended destruction. State laws set their own terms. The protocol notes that some jurisdictions store unreported kits for a limited period, such as 1, 5 or 10 years. In a cold case or a delayed civil claim, the kit's retention history is part of the record: ask for the storage log and any destruction notice along with the kit results.

Many jurors, and some lawyers, expect that a sexual assault leaves visible injury. The research says it often does not, and also that injury can follow consensual sex. A careful expert on either side will say both.

What the 2 studies found

A 2023 systematic review and meta-analysis by Naumann and colleagues pooled 10 studies with 3,165 female participants that compared the same exam techniques after sexual assault and after consensual intercourse. Anogenital injury was detected in 901 of 1,874 participants (48%) after assault and 394 of 1,291 (31%) after consensual sex. Injury was more likely after assault (risk ratio 1.59), though the authors report high heterogeneity between studies, note the ratio may be an overestimate, and found no significant difference when only high-quality studies were pooled. They conclude that the presence of injury "does not prove there has been sexual violence and absence of injury does not refute that sexual assault has occurred" (eClinicalMedicine, 2023).

A 2026 retrospective study by Buzzelli and colleagues reviewed 306 adults examined after reported sexual assault at a Berlin forensic outpatient clinic between 2016 and 2023. Extragenital injuries were documented in 216 cases (70.6%) and anogenital injuries in 62 (20.3%). Among 256 people who reported at least 1 oral, vaginal or anal act, a visible injury corresponding to the reported act was present in 72 (28.1%) and absent in 184 (71.9%) (Int J Legal Med, 2026).

Technique and timing are part of the finding

Detection depends on how and when the exam was done. The protocol describes magnification by colposcope or camera, toluidine blue dye "in some jurisdictions," and an alternate light source that can make both biological and non-biological substances fluoresce. The record should say which were used. A finding, or a negative finding, without the method and the time since the assault is only half a fact.

What an examiner may and may not say

"It is impermissible to testify about whether a patient consented to the sexual contact or whether they believe the patient was raped or assaulted. However, if a clinician is qualified as an expert, they may be permitted to testify about whether the patient's presentation was consistent with their history."

For how injury documentation works outside the sexual assault setting, see the blunt force trauma records guide and, where strangulation is part of the history, the non-fatal strangulation records guide, which pairs with this one.

The SANE record is protected health information, and in many states it carries more protection than an ordinary chart. Who may get it, and how, depends on who is asking, what the patient signed, what the court orders and what the state adds. The protocol names the federal layers: HIPAA, which limits release without written authorization but has exceptions such as mandatory reporting and subpoenas or court orders; HITECH; the 21st Century Cures Act on patient access; FERPA for some campus clinics; and the VAWA confidentiality rule at 34 USC 12291(b)(2) for grant-funded programs. It also notes that many state laws are broader than HIPAA.

Advocates, privilege and discovery

The protocol draws a sharp line between advocates. Information shared with government or system-based providers "usually becomes part of the criminal justice record," while community-based advocates "typically can provide some level of confidential communication," subject to state confidentiality and privilege law. It adds that whether a privilege exists "may depend on who is present during any one discussion with a patient," and that notes may still be reached by legal process. Once charges are filed, what the patient told law enforcement, prosecutors and system-based advocates will likely go to defense counsel through the prosecutor's discovery obligations. Many prosecutors seek protective orders to keep sensitive material out of open court.

These rules vary more by state than anything else in this guide. Our view: read the state's privilege rule before the first subpoena goes out. Guessing costs both sides months.

RE: [PATIENT NAME or KIT NUMBER], date of service [DATE], [FACILITY]

Please produce the complete record of the encounter above, including
records held outside the main medical record:

1. Emergency department record for the same visit: triage, medical
   screening exam, orders, results, nursing notes.
2. The complete medical forensic examination record, every page.
3. All consent, declination and authorization forms, with dates and times.
4. Body maps and diagrams, and the narrative findings.
5. The photograph log. Photographs to be produced only under
   [PROTECTIVE ORDER / TERMS], in native digital format with metadata.
6. Evidence kit inventory, seal record and every chain of custody form.
7. Toxicology collection records, courier or transfer forms, and results.
8. Medication administration records and prescriptions.
9. Discharge instructions, follow-up plans and records of follow-up contact.
10. The program protocol and documentation forms in force on [DATE].
11. The examiner's credentials in effect on [DATE].

If any category is withheld, identify it and the basis for withholding.
If a category does not exist (for example, audio or video recordings),
please say so in writing.

[NAME, ROLE, CONTACT]

For the general mechanics of authorizations and subpoenas, see how to get medical records for a lawsuit.

In a prosecution, the SANE record is usually offered through the examiner's testimony, and the patient's statements inside it raise 2 separate questions: is it hearsay that fits an exception, and does admitting it violate the defendant's right to confront witnesses.

Statements for medical diagnosis or treatment

The protocol notes that victims' statements to law enforcement are generally inadmissible at trial except in narrow circumstances, while statements to medical personnel may come in, and it cites the federal exception:

Federal Rule of Evidence 803(4) admits a statement, whether or not the speaker is available, if it was made for medical diagnosis or treatment and is reasonably pertinent to it, and if it describes medical history, past or present symptoms or sensations, their onset, or their general cause (FRE 803).

The fight is over "reasonably pertinent." Statements that guide care fit easily. Statements that identify a person or describe detail with no treatment purpose are contested, and states apply their own versions of the rule. The pediatric protocol cites State v. Mendez, 242 P.3d 328 (N.M. 2010), which requires courts to scrutinize statements to a SANE for trustworthiness in light of the medical purpose of the exception.

The Confrontation Clause

When the patient does not testify, the question becomes whether their statements to the examiner were "testimonial." The pediatric protocol's Appendix 5 summarizes the line of cases from Crawford v. Washington, 541 U.S. 36 (2004), through Davis v. Washington, 547 U.S. 813 (2006), and Michigan v. Bryant, 562 U.S. 344 (2011): only nontestimonial statements can be admitted without the witness testifying (Crawford itself allows testimonial statements of an unavailable witness only where the defendant had a prior chance to cross-examine). It notes that the Supreme Court had not ruled on how that applies to medical forensic exams specifically, that results in lower courts have been mixed, and that the answer depends on the jurisdiction. The dual purpose of the exam, care plus evidence, is exactly why both sides argue it.

The examiner as a witness

Examiners testify as fact witnesses, expert witnesses, or both. The protocol expects them to meet in advance with the attorney calling them, to use the documentation to refresh their recollection, reminds them that anything they write about the case, including texts and emails to counsel, may be discoverable, and says that although they are most often called by the prosecution, "they may also be called by the defense," and must give objective testimony either way. In federal cases, Federal Rule of Criminal Procedure 16(a)(1)(G)(iii) requires the government, at the defendant's request, to give a written expert disclosure with all opinions, their bases and reasons, the witness's qualifications including publications from the previous 10 years, and a list of cases from the previous 4 years in which the witness testified as an expert (FRCrP 16).

SANE records also enter civil suits, most often claims against an institution rather than an individual: a school or university, an employer, a health care facility, a residential or correctional setting, or a youth organization. In those cases the criminal questions of identity and consent often matter less than what the institution knew, when, and what it did. The SANE record is rarely the center of the case, but it anchors 3 things.

1. The date and the disclosure. The exam record fixes when the patient first sought care and what they reported for treatment. Notice and response arguments on both sides are built around that date.
2. The injuries and the care. Findings, medications, prophylaxis and follow-up are the start of the damages record. The defense will test causation with prior and later records; the plaintiff will use the record to show the course of care.
3. The institution's own records. Campus health files, incident reports, human resources files and facility records sit next to the SANE record. The protocol's audience list names college and university staff, including Title IX personnel, which tells you where campus files live.

Civil discovery of a SANE record usually runs through the patient's own authorization, because the patient is the plaintiff. That makes the scope decision the plaintiff's: produce the whole encounter, or fight over parts. Many practitioners produce the whole encounter under a protective order with separate terms for photographs, because partial productions tend to invite motions. Others limit scope to protect the patient's privacy. The rules of the court and the state decide what a party can withhold.

Quality review documents are a separate fight. The protocol says quality assurance documents are often protected under state peer review statutes and federal law, citing the Patient Safety and Quality Improvement Act, but that not every state protects all of them and the privilege can be lost. For child plaintiffs, the records work is closer to the child abuse medical records guide and the pediatric protocol.

J.R., an adult, arrives at an emergency department and asks for a sexual assault exam. The SANE file runs 22 pages, plus a 6 page ED chart and a 3 page lab report.

1. 03/07 02:10
   Arrival and triage

   ED triage note and medical screening exam. Patient reports a memory gap.

   ED chart p. 1 to 2
2. 03/07 03:05
   Examiner starts; consents signed

   Kit collection yes; toxicology yes; photographs limited to body surface. HIPAA authorization to release the kit to police signed separately.

   SANE p. 2 to 5
3. 03/07 03:20
   History and post-assault activities

   Changed clothes; did not bathe. Urine collected early because of the memory gap.

   SANE p. 6 to 9
4. 03/07 03:50
   Findings and photographs

   Body map shows 3 marks; narrative describes 3; photo log lists 3 body surface images plus the 2 identification photos.

   SANE p. 10 to 16
5. 03/07 04:52
   Kit sealed, 7 items

   Seal initials and time recorded.

   SANE p. 18
6. 03/07 05:15
   Medications and discharge

   Emergency contraception given; HIV PEP offered and declined; follow-up plan documented.

   SANE p. 19 to 22
7. 03/07 to 03/10
   No custody entry for the urine

   No record of who moved it from the ED refrigerator to the lab.

   Custody log; nothing found
8. 03/10 14:40
   Lab receipt lists 6 items

   The seal record says 7.

   Lab report p. 1

Both flags are questions, not conclusions. The prosecution's next move is to find the courier record and ask the lab how it itemizes a kit. The defense's next move is to ask for the refrigerator log, the lab's intake photographs and the program's transfer policy. On the rest of the file the record is consistent: marks, narrative and photographs match, the consent limits were honored, and the declined PEP is documented care.

SANE RECORD REVIEW: [CASE], reviewer [NAME], date [DATE]

A. Inventory
   Pages received: SANE ___  ED chart ___  lab ___  photos ___
   Parts missing (see checklist in chapter 4): ______________

B. Clocks
   Arrival ___  exam start ___  kit sealed ___  discharge ___
   Hours from reported assault to exam: ___ (source page ___)

C. Consent
   Each consent and declination, with page: ______________
   Separate HIPAA authorization for release? Y / N  page ___
   Any step done outside a consent? ______________

D. Findings
   Body map marks ___  narrative entries ___  photographs ___
   Do the 3 counts match? If not, list each mismatch with pages.

E. Evidence
   Items at seal ___  items at lab receipt ___
   Each transfer: date, time, from, to, page.
   Any liquid sample transfer unlogged?

F. Care
   Medications offered, given, declined, with pages.
   Follow-up plan and any follow-up contact records.

G. Open questions for the other side or the program

For a finished chronology format built on a forensic file, see the forensic case chronology sample.

SANE files are short compared with a hospital stay, but they are dense, partly handwritten and highly sensitive. That mix decides where AI medical record review helps. A large language model (LLM) or other clinical natural language processing tool can index pages, extract times, match counts and draft an AI medical chronology quickly. It can also misread a handwritten body map, merge 2 clocks, or state a finding the page does not contain.

The rule that makes this safe is human-in-the-loop review with page-level citation. Courts have already sanctioned lawyers who filed AI output without checking it; in Mata v. Avianca, Inc., 678 F. Supp. 3d 443 (S.D.N.Y. 2023), the court imposed Rule 11 sanctions over fictitious cases produced by ChatGPT. The same duty applies to facts drawn from a medical record. Keep a record of which tool touched which file, when, and who checked the output, so you can answer questions about the audit trail of the AI use. Agentic tools that retrieve or send records on their own add risk here and deserve extra scrutiny. Ambient AI scribe tools used at some hospitals can also create note text the examiner did not type; ask whether one was in use on the exam date.

Related reading: HIPAA-compliant AI medical record review, can AI read handwritten medical records and is AI accurate enough for court.

Medrecords AI is medical chronology software for legal and medical review teams. On a SANE file it does the reading work described in chapters 4, 5 and 10, and leaves the judgment to you.

1. Chronology. An AI medical chronology that orders every timed entry from the ED chart, the SANE form and the lab report, each cited to the source page.
2. Handwriting and scans. OCR and handwritten record extraction for form checkboxes and examiner notes, with the page image a click away for checking.
3. Gaps and undated pages. Missing records identification and undated document flagging, as signals for a follow-up request.
4. Changes and redaction. Record alteration detection flags pages that may have changed between productions, and redaction prepares copies for filing or wider sharing.

What it does not do: it does not retrieve records, examine patients, offer opinions on injuries, give legal advice, or sign an opinion. Flags are signals, not verdicts. It runs under SOC 2 and HIPAA with a BAA; see security and HIPAA. Self-Service bills 10 cents a deduplicated page, down to 5 cents at volume, duplicates free; Enterprise On-Prem is an annual license (pricing).

Does a patient have to report to police to get a SANE exam?

No. Under 34 USC 10449, states that receive the relevant VAWA funds must provide the exam without requiring the patient to participate in the criminal justice system or cooperate with law enforcement.

Who pays for a SANE exam?

Under 34 USC 10449, states that take the relevant VAWA funds must cover the full out-of-pocket cost of the forensic exam: a government entity either provides it free of charge or arranges for the patient to get it free of charge, and a copayment or deductible counts as out-of-pocket cost. Medical care beyond the forensic exam may be billed separately.

How long after an assault can a SANE exam be done?

The protocol treats 5 days (120 hours) as the general evidence window, while noting that exams can still help after that. Toxicology, emergency contraception and HIV PEP each run on their own clocks: 120 hours for urine toxicology and emergency contraception, 24 hours for blood toxicology, and 72 hours to start HIV PEP.

Can the patient get a copy of their own SANE record?

Yes. The protocol says patients are entitled to access their exam records through the agency that performed the exam.

Does the absence of injury mean an assault did not happen?

No. In the 2023 meta-analysis, 48% of assault survivors had detectable anogenital injury, so more than half did not, and 31% of women after consensual sex did. Injury findings neither prove nor disprove consent on their own.

Can the defense get the SANE examiner's notes?

Often, through discovery or a subpoena, subject to state privilege law and any protective order. The protocol warns examiners that anything they write about the case, including texts and emails to counsel, may be discoverable.

Is it HIPAA compliant to upload SANE records to AI software?

Only if the vendor signs a business associate agreement, protects the data under audited controls such as SOC 2, and does not train on your files. Without a BAA, uploading protected health information to a general tool is a disclosure risk.

Can ChatGPT summarize a SANE exam record?

A consumer chatbot is the wrong tool for this file. It offers no BAA by default, may hallucinate times or items, and gives no page cites. Use legal AI built for medical records, and check every line.

Can AI read handwritten body maps and checkboxes?

Good OCR and handwriting recognition can read most typed forms and many handwritten notes, but checkboxes and body map labels are where errors cluster. Every extracted count should be checked against the page image.

Does AI replace a forensic nurse or expert witness?

No. AI medical record review speeds up indexing, timelines and gap lists. Interpreting findings, testifying and forming opinions remain the work of qualified people who have read the record themselves.

Every number, quotation and rule in this guide was checked against a primary source in September 2026. Where a fact could not be confirmed from a primary source, it was left out. Protocol quotations are from the text of the documents below; section names are not given because page layout varies between editions. Hypotheticals are labeled and use invented initials, times and numbers.

• U.S. Department of Justice, Office on Violence Against Women. A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents, 3rd ed., 2024. Source of the evidence windows, photograph standards, consent, documentation, storage, chain of custody and testimony guidance.
• U.S. Department of Justice, Office on Violence Against Women. A National Protocol for Sexual Abuse Medical Forensic Examinations: Pediatric, 2016. Source of the Crawford, Davis, Bryant and Mendez summary.
• 34 USC 10449, exam payment and no reporting requirement.
• 18 USC 3772, survivors' rights, including the 20 year and 60 day kit rules.
• Federal Rule of Evidence 803(4) and Federal Rule of Criminal Procedure 16.
• 45 CFR 164.508, HIPAA authorizations, and 20 USC 1232g, FERPA.
• Naumann DN and colleagues. Anogenital injury following sexual assault and consensual sexual intercourse: a systematic review and meta-analysis. eClinicalMedicine, 2023.
• Buzzelli A and colleagues. Visible injury patterns in relation to reported sexual acts after sexual assault: a retrospective cohort study. International Journal of Legal Medicine, 2026.
• Mata v. Avianca, Inc., 678 F. Supp. 3d 443 (S.D.N.Y. 2023).
• RAINN, National Sexual Assault Hotline, 800-656-4673, checked on rainn.org.

State law on privilege, kit retention and minors' consent varies widely and changes often. Check your state's current statutes before relying on any general statement here. Related guides: child abuse medical records, how to read an autopsy report, non-fatal strangulation records and toxicology reports in litigation.