1 

OSAC 2023-N-0014 

Standard Guiding Principles 

for the Medical Forensic 

Examination 

Forensic Nursing Subcommittee 

Medicine Scientific Area Committee 

Organization of Scientific Area Committees (OSAC) for Forensic Science 
2 

OSAC 2023-N-0014 Standard Guiding Principles for 

the Medical Forensic Examination 

Draft OSAC Proposed Standard 

OSAC 2023-N-0014 

Standard Guiding Principles for the 

Medical Forensic Examination 

Prepared by 

Forensic Nursing Subcommittee 

Version 1.0 

September 2023 

Disclaimer: 

This OSAC Proposed Standard was written by the [insert subcommittee or other unit name] of the 

Organization of Scientific Area Committees (OSAC) for Forensic Science following a process that 

includes an open comment period. This Proposed Standard will be submitted to a standards 

developing organization and is subject to change. 

There may be references in an OSAC Proposed Standard to other publications under development 

by OSAC. The information in the Proposed Standard, and underlying concepts and methodologies, 

may be used by the forensic-science community before the completion of such companion 

publications. 

Any identification of commercial equipment, instruments, or materials in the Proposed Standard 

is not a recommendation or endorsement by the U.S. Government and does not imply that the 

equipment, instruments, or materials are necessarily the best available for the purpose. 

 
1 

1 Foreword 

2 This document provides standard guiding principles that shall govern the conduct of medical 

3 forensic examinations by trained clinicians. These foundational principles assure forensic patient 

4 care is patient centered and trauma informed while protecting the clinician’s safety and the 

5 integrity of evidence. 

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7 This document should be utilized in conjunction with any requirement by state or federal laws, 

8 licensing boards, local regulations, and by the clinician’s healthcare organization. These guiding 

9 principles should inform or augment policies relating to the conduct of the medical forensic 

10 examination. 

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12 All hyperlinks and web addresses shown in this document are current as of the publication date of 

13 this standard. 

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15 This document has been drafted by the Forensic Nursing Subcommittee of the Organization of 

16 Scientific Area Committees (OSAC) for Forensic Science through a consensus process. 

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OSAC 2023-N-0014 Standard Guiding Principles for 

the Medical Forensic Examination 

46 Table of Contents 

47 

48 1. Scope Page 5 

49 2. Normative References Page 5 

50 3. Terms and Definitions Page 5 

51 4. Requirements Page 6 

4.1 Trauma-informed Approach to Care 

4.2 Patient-centered Approach to Care 

4.3 Medical Safety and Well-being of the Patient 

4.4 Equity 

4.5 Patient Autonomy and Privacy 

4.6 Personnel Safety 

4.7 Scope of Practice 

4.8 Competency and Currency of Practice 

4.9 Scientific Reliability and Validity 

4.10 Preserving Context 

4.11 Maintaining Evidence Integrity 

4.12 Transparency 

4.13 Managing Cognitive Bias 

52 Annex A (informative) Bibliography Page 10 
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OSAC 2023-N-0014 Standard Guiding Principles for 

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53 1. Scope 

54 This document provides standard guiding principles for the medical forensic examination of 

55 patients (victims and suspects) by a trained medical forensic examiner following suspected or 

56 disclosed violence. These principles shall set the foundation for medical forensic services provided 

57 to patients that assures care is patient centered and trauma informed while protecting the clinician’s 

58 safety and the integrity of evidence. The absence of law enforcement involvement does not nullify 

59 the clinician’s duty to provide medical forensic patient care that abides to these standards. 

60 

61 2. Normative References 

62 a. U.S. Department of Justice. A National Protocol for Sexual Assault Medical Forensic 

63 Examinations: Adults/Adolescents (2nd Ed.). U.S. Department of Justice, Office on Violence 

64 Against Women; 2013. 

65 

66 3. Terms and Definitions 

67 

68 For purposes of this document, the following definitions and acronyms apply. 

69 3.1 Autonomy: The ability to make your own decisions without being controlled by 

70 anyone else (Cambridge University Press, n.d.). 

71 

72 3.2 Cognitive Bias: A set of influences that may affect the reliability and validity of one’s 

73 observations and conclusions (OSAC Lexicon). 

74 

75 3.3 Competent: Having the skills or knowledge to do something well enough to meet a basic 

76 standard (Cambridge University Press, n.d.) 

77 3.4 Context: Spatial and temporal associations of evidence (OSAC Lexicon). 

78 3.5 Equity: The situation in which everyone is treated fairly according to their needs and no 

79 group of people is given special treatment (Cambridge University Press, n.d.) 

80 3.6 Evidence integrity: Ensuring the physical security, completeness, and accuracy of 

81 evidence is maintained from the time it is collected until its final disposition to prevent any 

82 claims of mishandling or tampering and guarantee its acceptance in a court of law (National 

83 Institute of Justice, 2020). 

84 3.7 Medical forensic examiner: A healthcare provider who applies medical knowledge and 

85 practices to the investigation of the medicolegal aspects of death, injury, neglect, or behavior 

86 (adapted from National Commission on Forensic Sciences, n.d.). 

87 3.8 Medical forensic examination: An examination of a patient by a medical forensic 

88 examiner following suspected or disclosed violence. The examination includes gathering 

89 information from the patient for the medical forensic history; an examination; coordinating 

90 treatment of injuries, documentation of biological and physical findings, and collection of 

91 evidence from the patient; documentation of findings; information, treatment, and referrals for 

92 STIs, pregnancy, suicidal ideation, alcohol and substance abuse, and other nonacute medical 

93 concerns; and follow-up as needed to provide Standard Guiding Principles for the Medical 

94 Forensic Examination additional healing, treatment, or collection of evidence (adapted from 
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OSAC 2023-N-0014 Standard Guiding Principles for 

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95 normative reference a). 

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97 3.9 Reliability: Extent to which an experiment, test, or measuring procedure yields the same 

98 results on repeated trials (OSAC Lexicon). 

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100 3.10Scope of practice: A set of activities and procedures that a healthcare professional is 

101 authorized to perform based on their education, training, and license. It is defined by each 

102 profession's regulatory board or licensing agency and varies by state and country (American 

103 Nurses Association, 2021). 

104 

105 3.11Transparency: The quality of being done in an open way without secrets (Cambridge 

106 University Press, n.d.). 

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108 3.12Validity: Extent to which a conclusion, inference or proposition is accurate (OSAC 

109 Lexicon). 

110 

111 4. Requirements 

112 

113 The purpose of a medical forensic examination is to address patients’ healthcare needs and 

114 collect evidence when appropriate for potential use within the criminal justice system (DOJ, 

115 2013). The medical forensic examiner endeavors to locate, document, collect and preserve items 

116 of potential evidentiary value that are identifiable at the time of exam, while providing medical 

117 care to support the recovery of the patient. Each case is unique and requires medical personnel 

118 to continuously evaluate how to proceed with conducting a medical forensic examination in a 

119 manner that is safe for both patient and examiner and best preserves the evidence and its context. 

120 Thus, all decisions made by a medical forensic examiner before, during, and after a medical 

121 forensic exam should consider the following guiding principles: 

122 

123  Trauma-informed Approach to Care 

124  Patient-centered Approach to Care 

125  Medical Safety and Well-being of the Patient 

126  Equity 

127  Patient Autonomy and Privacy 

128  Personnel Safety 

129  Scope of Practice 

130  Competency and Currency of Practice 

131  Scientific Reliability and Validity 

132  Preserving Context 

133  Maintaining Evidence Integrity 

134  Transparency 

135  Managing Cognitive Bias 

136 

137 Though all the guiding principles listed in this document are important, some circumstances 

138 could require a medical forensic examiner to give greater weight to one principle over another. 

139 A decision to deviate from a guiding principle shall be documented and explained. 

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OSAC 2023-N-0014 Standard Guiding Principles for 

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143 4.1 Trauma-informed Approach to Care 

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145 The program or organization providing the medical forensic examination shall use a trauma146 informed approach to care. Such an organization “realizes the widespread impact of trauma 

147 and understands potential paths for recovery, recognizes the signs and symptoms of trauma in 

148 clients, families, staff, and others involved with the system; and responds by fully integrating 

149 knowledge about trauma into policies, procedures, and practices, and seeks to actively resist 

150 re-traumatization” (SAMHSA, 2014, p.9). 

151 

152 4.2 Patient-centered Approach to Care 

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154 The medical forensic examiner conducting the medical forensic examination shall administer 

155 care using a patient-centered approach. This approach includes: 1) a systematic focus on the 

156 needs and concerns of the patient; 2) ensuring the compassionate and sensitive delivery of 

157 services in a nonjudgmental manner; and 3) minimization of retraumatization associated with 

158 the criminal justice process. A victim advocate and/or related service provider shall be offered 

159 to the patient (OVC, n.d.). 

160 

161 4.3 Medical Safety and Well-being of the Patient 

162 

163 Assuring the medical safety and well-being of the patient distinguishes the responsibilities of 

164 the medical forensic examiner from crime scene investigators. The medical safety of the patient 

165 shall take priority over the conduct of the forensic medical examination. Additionally, the 

166 examiner shall support the patient’s mental and physical well-being during the medical forensic 

167 examination process. 

168 

169 4.4 Equity 

170 

171 Examiners shall provide equitable access to culturally competent medical forensic examinations 

172 regardless of the patient’s race, ethnicity, age, ability, sex, gender identity or expression, sexual 

173 orientation, nationality, socioeconomic status, and geographical location. 

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175 4.5 Patient Autonomy and Privacy 

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177 To protect the patient’s rights and the interests of the facility in which the examination is being 

178 conducted, consent or assent (in cases where the patient legally requires a surrogate decision179 maker) shall be obtained from the patient prior to conducting the 

180 206 medical forensic examination. 

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182 4.6 Personal Safety 

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184 Conducting medical forensic examinations, even in the hospital setting, can present a wide 

185 range of risk to personnel, including physical, biological, chemical, and situational hazards. 

186 Medical forensic examiners shall not be exposed to an unreasonable level of risk to personal 

187 safety and shall be provided with the equipment and training necessary to mitigate risks, such 

188 as personal protective equipment. 
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OSAC 2023-N-0014 Standard Guiding Principles for 

the Medical Forensic Examination 

189 4.7 Scope of Practice 

190 

191 Medical forensic examiners shall conduct the medical forensic exam within their scope of 

192 practice established by their profession and licensing body. 

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194 4.8 Competency and Currency of Practice 

195 

196 Medical forensic examiners shall maintain competency and currency of practice through 

197 initial didactic and clinical training, followed by ongoing continuing education. 

198 

199 4.9 Scientific Reliability and Validity 

200 

201 Medical forensic examiners shall use scientifically reliable and valid methods and practices 

202 based on best practices, peer-reviewed studies, and/or validated techniques. When applicable, 

203 methods, practices and analytical procedures published in the OSAC Registry shall be 

204 employed. 

205 

206 4.10 Preserving Context 

207 

208 Medical forensic examiners shall document the medical forensic examination in such a way 

209 that it preserves the context of the evidence to ensure others can later understand what, where, 

210 how, and in what condition evidence was found and how it pertains to the patient’s history. 

211 

212 4.11 Maintaining Evidence Integrity 

213 

214 Medical forensic examiners shall take appropriate steps to maintain evidence integrity by

215 preventing contamination, tampering, alteration, or loss of evidence. Procedures and

216 documents shall be utilized to account for the integrity and possession of evidence by tracking 

217 its handling and storage from its point of collection to its final disposition. 

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219 4.12 Transparency 

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221 The medical forensic examiner shall provide documentation and testimony about the medical 

222 forensic examination that clearly represents the patient’s presentation, the examiner’s and 

223 patient’s actions during the examination, and any other information the examiner identifies as 

224 pertinent at the time of examination. If an action by a medical forensic examiner intentionally 

225 deviates from, or sets aside, one of the principles, the circumstances and justification shall be 

226 fully documented. 

227 

228 4.13 Managing Cognitive Bias 

229 

230 Cognitive bias refers to the class of effects by which an individual’s preexisting beliefs, 

231 expectations, motives, and situational context may influence their collection, perception, or 

232 interpretation of information, or their resulting judgments, decisions, or confidence (Spellman 

233 et al., 2021). Medical forensic examiners are uniquely positioned at the intersection of 

234 healthcare and scientific investigations. Examiners shall identify, document, and collect 
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OSAC 2023-N-0014 Standard Guiding Principles for 

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235 statements and other potential evidence as objectively as possible. Medical forensic examiners 

236 shall take steps to mitigate effects of cognitive biases on their work.
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OSAC 2023-N-0014 Standard Guiding Principles for 

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237 Annex 

238 

239 Bibliography 

240 

241 This is not meant to be an all-inclusive list as the group recognizes other publications on this 

242 subject may exist. At the time this document was drafted, these were some of the publications 

243 available for reference. Additionally, any mention of a particular software tool or vendor as part 

244 of this bibliography is purely incidental, and any inclusion does not imply endorsement by the 

245 authors of this document. 

246 

247 American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). 

248 Nursesbooks.org. 

249 

250 Cambridge University Press. (n.d.). Meanings & definitions. Cambridge Dictionary. 

251 https://dictionary.cambridge.org/

252 

253 National Commission on Forensic Science. (n.d.). Views document on definitions. 

254 https://www.justice.gov/archives/ncfs/page/file/477836/download

255 

256 National Institute of Justice. (2020). National best practices for sexual assault kits: A 

257 multidisciplinary approach. Office of Justice Programs, U.S. Department of Justice. 

258 

259 Organization of Scientific Area Committees (OSAC) for Forensic Science, Crime Scene 

260 Investigation Subcommittee. (2021). Guiding Principles for Scene Investigation and 

261 Reconstruction (OSAC 2021-N-0015). OSAC, National Institute of Standards and 

262 Technology, US Department of Commerce. 

263 https://www.nist.gov/system/files/documents/2021/09/02/OSAC%202021-

264 N0015%20Guiding%20Principles%20for%20CSI_FINAL%20OSAC%20PROPOSED%

265 20FOR%20REGISTRY.pdf

266 

267 Spellman, B. A., Eldridge, H., & Bieber, P. (2021). Challenges to reasoning in forensic science 

268 decisions. Forensic Science International. Synergy, 4, 100200. 

269 https://doiorg.mutex.gmu.edu/10.1016/j.fsisyn.2021.100200