Careful documentation in the medical record is crucial in domestic violence cases. Such documentation can assist the victim who seeks legal remedies such at temporary or permanent restraining orders, child custody, separation, or divorce. It is recommended that photographs of visible injuries be included. Be sure to obtain consent and to document the date and time of the photographs. A hand-drawn body map detailing areas of tenderness or hematomas should be included to document nonvisible injuries. Physicians for a Violence-free Society, which has developed materials to help physicians incorporate forensic documentation into their practices, can be contacted at 415-821-8209. Emergency physicians must be aware of their state's reporting requirements. Some states have mandatory reporting of known or suspected domestic violence; others have mandatory arrest, in addition to mandatory reporting. If the police are called, either at the woman's request or because of a reporting requirement, it is important to discuss a safety plan with the woman. Violence may escalate when the batterer discovers he has been reported, especially if he is not arrested, or if he is arrested but held for only a short period. Physicians must warn potential victims if serious homicidal intent is expressed. Failure to report domestic violence and reporting suspected domestic violence that is not substantiated are both potential sources of physician liability. States in which mandatory reporting exist should have liability protections similar to those for reporting suspected child abuse.
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