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Provider Sexual Crime Reports

The Office of Grants and Research facilitates the legislatively-mandated reporting on medical responses to reports of rape and sexual assault.



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Mass General Law (M.G.L. Ch. 112, Sec. 12A 1/2) requires the reporting of all cases of rape and sexual assault where the victim sought medical treatment, regardless of whether the case was reported to police. To fulfill this requirement and facilitate uniform reporting by medical providers across the Commonwealth, a Provider Sexual Crime Reporting (PSCR) Form is used. After a victim undergoes an examination at a medical facility, the attending care provider is required to complete the PSCR form and fax it to the Office of Grants and Research and the local police department in the jurisdiction where the assault took place.

The Office of Grants and Research's Research and Policy Analysis Division (RPAD) records and maintains the data from the PSCR in a master database. Information gleaned from these reports helps guide discussion for the MSAECK Advisory Committee and public safety officials regarding emerging trends and the nature and characteristics of sexual assault in Massachusetts.

The Provider Sexual Crime Report Form is located within the Massachusetts Sexual Assault Evidence Collection Kit, which is distributed to Massachusetts hospital emergency departments on an annual basis. Medical providers can also access the forms in the "Provider Sexual Crime Report Forms" section of this page.

Provider Sexual Crime Report Forms

The PSCR Forms are available here and also located within each Massachusetts Sexual Assault Evidence Collection Kit. Completed forms should be faxed to 617-725-0260.

Adult Provider Sexual Crime Report Form

Pediatric Provider Sexual Crime Report Form

Contact   for Provider Sexual Crime Reports


(617) 725-0260

Completed PSCR forms should be faxed to this number.

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