MA SANE Protocols for SANEs and Emergency Department Clinicians

This protocol provides guidance to MA SANE clinicians and Emergency Department Clinicians regarding best-practice guidelines for sexual assault patients 12 years of age and older. Translated forms are available at the bottom of this page.

Protocol sections

• Protocol Cover Page (PDF) | (DOCX)
• Section I: Introduction (PDF) | (DOCX)
• Section II Roles and Responsibilities (PDF) | (DOCX)
• Section III: Mandatory Reporting (PDF) | (DOCX)
• Section IV: Obtaining Patient Consent (PDF) | (DOCX)
• Section V: Caring for Patients in the Intensive Care Unit/Operating Room (PDF) | (DOCX)
• Section VI: Special Considerations for Vulnerable Populations (PDF) | (DOCX)
• Section VII: Emergency Contraception (PDF) | (DOCX)
• Section VIII: Sexually Transmitted Infections (STIs) (PDF) | (DOCX)
• Section IX: SANE Forensic Examination (PDF) | (DOCX)
• Section X: Victim Compensation (PDF) | (DOCX)

Appendixes

• Appendix 1: Service Delivery Map
• Appendix 2: Hospital Interpreter Services (PDF) | (DOCX)
• Appendix 3: Assessing Patient Readiness for Adult/Adolescent SANE Examination (PDF) | (DOCX)
• Appendix 4: Adolescent Speculum Examination Algorithm (PDF) | (DOCX)
• Appendix 5: Emergency Contraception Options (updated 6/2019) (PDF) | (DOCX)
• Appendix 6: STI Testing Protocol (PDF) | (DOCX)
• Appendix 7: References (PDF) | (DOCX)

Form 1 Consent

• Form 1 Consent – Albanian
• Form 1 Consent – Arabic
• Form 1 Consent – Cape Verdean Creole
• Form 1 Consent – Haitian Creole
• Form 1 Consent – Khmer
• Form 1 Consent – Portuguese
• Form 1 Consent – Russian
• Form 1 Consent – Simplified Chinese
• Form 1 Consent – Somali
• Form 1 Consent – Spanish
• Form 1 Consent – Traditional Chinese
• Form 1 Consent – Vietnamese

Form 7 Aftercare

• Form 7 Aftercare - Albanian
• Form 7 Aftercare - Arabic
• Form 7 Aftercare - Cape Verdean Creole
• Form 7 Aftercare - Haitian Creole
• Form 7 Aftercare - Khmer
• Form 7 Aftercare - Portuguese
• Form 7 Aftercare - Russian
• Form 7 Aftercare - Simplified Chinese
• Form 7 Aftercare - Traditional Chinese
• Form 7 Aftercare - Somali
• Form 7 Aftercare - Spanish
• Form 7 Aftercare - Vietnamese

Form 7 Treatment and Discharge

• Form 7 Treatment and Discharge - Albanian
• Form 7 Treatment and Discharge - Arabic
• Form 7 Treatment and Discharge - Cape Verdean Creole
• Form 7 Treatment and Discharge - Haitian Creole
• Form 7 Treatment and Discharge - Khmer
• Form 7 Treatment and Discharge - Portuguese
• Form 7 Treatment and Discharge - Russian
• Form 7 Treatment and Discharge - Simplified Chinese
• Form 7 Treatment and Discharge - Traditional Chinese
• Form 7 Treatment and Discharge - Somali
• Form 7 Treatment and Discharge - Spanish
• Form 7 Treatment and Discharge - Vietnamese

SOP Discharge

• SOP Discharge - Brazilian Portuguese
• SOP Discharge - Cape Verdean Creole
• SOP Discharge - Haitian Creole
• SOP Discharge - Portuguese
• SOP Discharge - Russian
• SOP Discharge - Simplified Chinese
• SOP Discharge - Spanish
• SOP Discharge - Vietnamese