Eo EVIDENCE SUBMISSION FORM (esr) ere are ere eens
fen, 17-14;
o ‘Scorer es re a, ihn (Mita
CES am
oe remnant Aame eDN air
{LIMESTATUS OF THS CASE CHANGIS, PLEASE NOTIFY THE CASK MANAG eXTUNIT suey 340, 10884a
SEXUAL ASSAULT EVIDENCE COLLECTION KIT
TNOIDENT REPORTED TO POLICE?
No: D0 NOT RECORD VICTIM'S NAME ON KIT
aL yoo, eves RECORD VCTS HAE He
Sr ron at os NeDENT OCCURRED
Gimeno oa stg) SUBHTTED INTRANSPORT EAS?
conan rN tn REGUIRE DRYING S
>ARATE COMPREHENSIVE TOKICOLOGY KIT USED?
/ANES yes, Consent or Conrehensve Tevicoogy Testing MUST be competed anc laced n toxicology kt) INO
FOR HOSPITAL PERSONNEL
Hosprravcunic:__‘Se. Lurker eae {
Powe nuwaenrext, FOF. 5
CLINICIAN(S):
ose
ak pices ae
rirsencoer —_ Kateinloligean bo] =
: _PLACE RITIN SPCUREDAREA sg
piace by: K (Ween. L en Rf aA 2
ome:__“YPof to ~ Twe: Pad oe ee
FORPOLCE PERO
CHAIN OF POSSESSION
neceiven row MCiNe Sat Suse)
POLICE IDENTIFICATION No: # oxrNZO}!e_ rnee:\Lorie on
RECEIVED BY: acency. W429 OD .
ATE:
RECEIVED FROM:
POUCEIDENTECATON! |
RECEIVED ay:
DATE: i
PROMPTLY HAND CARRY ALL
‘101
Ske acess a
Erecutice Uffce of Pablo Sofely e
Htsa
“Sr