Sexual Assault Forensic Examiner (SAFE) Program

New York State Department of Health (DOH) has established standards to certify three distinct Sexual Assault Forensic Examiner (SAFE) Program components. Click each link below for more information and program applications.

SAFE-Designated Hospitals

New York State Sexual Assault Forensic Examiner (SAFE)-Designated Hospital Programs provide specialized care to sexual assault patients. Qualifying hospitals licensed under Article 28 of the Public Health Law seeking SAFE designation can apply to the Bureau of Perinatal, Reproductive, and Sexual Health (BPRASH) at any time. Once approved, a provider agreement with DOH, Division of Family Health obligates all hospitals to provide services consistent with SAFE Program requirements. SAFE hospital designation is not reviewed by the Office of Health Systems Management or added to the operating certificate but it is listed on the hospital profile.

Forms and Applications:

• SAFE Program Overview and Standards (PDF)
• Hospital Application (PDF)
• Hospital Agreement (PDF)

Note: Per Public Health Law 2805-i, every hospital in New York State is required to provide care to patients of sexual assault in the emergency department. Emergency departments are required to establish and implement policies and procedures for the treatment of rape victims; have procedures in place for contacting rape victim advocates; and, collect and maintain forensic evidence utilizing the New York State standardized evidence collection kits and procedures, including second kits for suspected drug-facilitated rape incidents, when appropriate. See below for a list of service components regarding the treatment of sexual assault patients required for all hospitals.

For a list of all New York State licensed emergency departments, visit NYS Health Profiles.

DOH-Designated SAFE Hospital Program Requirements Compared to Hospitals Without a DOH-Designated SAFE Program:

SAFE-Designated Hospitals by County:

Erie

DOH-Certified SAFE Training

DOH certifies Adult/Adolescent SAFE training courses. SAFE training is essential for any DOH-designated hospital program to establish a cohort of medical professionals who are prepared to conduct sexual assault medical forensic examinations, collect and preserve evidence, and present testimony in the prosecution of sexual assault cases. A 40-hour didactic and clinical training course, which demonstrates to the Department the ability to provide training that meets the minimum standards and requirements, can provide training related to the Department's issuance of certificates of qualifications.

Forms and Applications:

• SAFE Program Overview and Standards (PDF)
• Training Application (PDF)
• Training Agreement (PDF)
• Preceptor Qualification (PDF)
• Preceptor Agreement (PDF)

Approved Adult/Adolescent Courses:

Currently there are five active DOH-certified Sexual Assault Forensic Examiner (SAFE) training courses offered throughout New York State. The International Association of Forensic Nurses (IAFN) also offers a DOH-approved online training course for SAFE-A. Visit IAFN for more information.

Sexual Assault Forensic Examiners

The DOH recommends SAFEs/SANEs in all hospitals to provide comprehensive and high quality medical care, collection of forensic evidence, and respectful and sensitive treatment. The use of DOH-certified SAFEs is required in hospitals seeking SAFE designation.

Forms and Applications:

• NYSAFE Program Overview and Standards (PDF)
• NYSAFE Certification Application (PDF)
• NYSAFE Training Course Exemption attachment (PDF)
• NYSAFE Recertification Application (PDF)

Additional Resources for Interested Medical Professionals and Examiners:

• Forensic Healthcare Online
• Forensic Nurses News
• How to Become a Sexual Assault Nurse Examiner
• IAFN New York Chapter
• IAFN SAFE Technical Assistance
• IAFN Tribal Forensic Healthcare

For additional guidance on providing services to victims of sexual assault in the health care setting, refer to the U.S. Department of Justice Office on Violence Against Women "A National Protocol for Sexual Assault Medical Forensic Examinations".

The New York State Sexual Assault Victim Bill of Rights

The 'New York State Sexual Assault Victim Bill of Rights' must be provided to every presenting sexual offense victim before a medical facility commences a physical examination of a sexual offense victim, or a police agency, prosecutorial agency or other law enforcement agency commences an interview of a sexual offense victim. The health care professional conducting the exam, police agency, prosecutorial agency or other law enforcement agency shall inform the victim of the victim's rights by providing a copy of this sexual assault victim bill of rights and offering to explain such rights. Also available in the following languages: Arabic, Bengali, French, Haitian Creole, Italian, Korean, Polish, Russian, Simplified Chinese, Spanish, Urdu, Yiddish.

Sexual Offense Evidence Collection Kit and Drug Facilitated Sexual Assault Kit:

When a patient has been sexually assaulted, the primary focus is on assessing the immediate health care needs and secondly, the collection and preservation of evidence. The New York State Division of Criminal Justice Services (DCJS), in conjunction with DOH and crime labs in New York State, developed a sexual offense evidence collection kit for the collection and preservation of sexual assault forensic evidence. In addition, a Drug Facilitated Sexual Assault (DFSA) kit was developed to be used only in cases where there is a suspicion of a drug facilitated sexual assault. DFSA kits must be used in conjunction with the evidence collection kit. Evidence collection and DFSA kits are provided by DCJS at no cost to hospitals in the state. For more information, visit DCJS.

Evidence Collection Timeframe:

NYS DOH follows The National Institute of Justice (NIJ) National Best Practices https://nij.ojp.gov/topics/articles/national-best-practices-sexual-assault-kits-multidisciplinary-approach which recommends the following: “Guided by the victim history, sexual assault samples should be collected from any victim seeking care as soon as possible and up to five (5) days or longer post-assault.” More information regarding this timeframe can be found here https://www.ojp.gov/pdffiles1/nij/250384.pdf.

Storage:

Accurately maintaining and accounting for the chain of custody of sexual offense evidence is essential for the evidence to be useful in a court of law. A patient, family member, or support person should never be left alone with evidence or ever allowed to handle or transport evidence after it has been collected. Public Health Law 2805-i provides that all sexual offense evidence shall be kept in a locked, separate and secure area for 20 years from the date of collection unless the patient directs their evidence be surrendered to law enforcement, the patient directs their evidence be disposed of, or for certain kinds of evidence, if law enforcement request its surrender. At the time of evidence collection, all hospitals must obtain patient consent to either transfer evidence to the Office of Victim Services’ storage facility or release evidence to law enforcement. Hospitals are required to immediately contact law enforcement on behalf of the patient or transfer evidence within 10 days of collection to the storage facility. For more information on evidence storage and transfers, please visit: Sexual Offense Kits (ovs.ny.gov).

OVS follows the National Institute of Justice (NIJ) National Best Practices recommendations for environmental conditions at its storage facility.

Per NIJ guidance, items must be stored in a secure location in the following types of environments:

• SOEC Kits – between 60° and 75° F with less than 60 percent humidity
• DFSA Kits – between 36° and 46° F with less than 25 percent humidity
• Additional items collected such as clothing – between 60° and 75° F with less than 60 percent humidity

No item should be kept outside of these conditions for more than 24 hours.

Items that were previously stored in a freezer do not need to stay frozen but should be kept at the temperature and humidity conditions appropriate to the type of item.

If there is any moisture or condensation on the outside of the container, allow the item to dry before placing it in another container or touching another item.

Patient Consent:

The entire health care and evidentiary exam is conducted at the patient's discretion. The patient may withdraw consent at any time, or may choose to complete only certain parts of the health care exam, evidentiary exam, or health care treatment. Written, informed consent for medical care and HIV testing must be obtained. In addition, consent must be obtained for collection and storage of sexual offense evidence, including forensic photography*. A signed consent for release of information and privileged evidence to law enforcement is required. The patient must also sign a release directing the hospital not to collect and keep privileged evidence, if the patient chooses not to participate in an evidentiary exam.

• It is the consenting patient's choice whether to involve law enforcement personnel or not. However, the health care provider has a legal obligation to report injuries including gunshot wounds or other injuries arising from the discharge of a firearm, or a wound which is likely to result in death and is actually or apparently inflicted by a knife, ice pick, or other sharp instrument.
• If a suspected sexual assault patient is unconscious, the hospital should follow established procedures for the care and treatment of the unconscious patient.
• A mature minor who presents at a hospital emergency department may consent or may choose not to consent, without parental involvement, to a forensic exam, in the course of post-sexual assault care

Forensic photography consent:

• When collecting other forensic evidence: Informed consent must be obtained from the patient. The consent form found in every Sexual Offense Evidence Collection Kit (SOECK) includes a section specific to photos. This should be used for patients having forensic evidence collected. A copy of this form should be kept in the patients' medical record.
• When not collecting other forensic evidence: The Department recommends that all hospitals have separate written consent forms to take and store forensic photographs. If the hospital, in consultation with their legal counsel, determine that the hospital's general consent for treatment includes provisions relating to the taking and storing of patient photographs, then the Department recommends that the photography section of the general consent for treatment is clearly distinguished from other consents so that the patient is truly giving informed photography consent, and that the patient has an option to only opt out of the photography consent. Generally, photographs are not considered medical treatment and are not covered by the general consent for treatment. Patients who decline or are not eligible for SOECK may still consent to forensic photography.
• Forensic photographs do not go to the crime lab for processing. Therefore, do not include photos of any format (prints, memory sticks, other electronic storage devices) in the Sexual Offense Evidence Collection Kit or package them as additional forensic evidence (such as with clothing and other physical evidence). Photographs are stored by the hospital and noted in the patient medical record.
• Patient written consent to release medical records to law enforcement does not pertain to forensic photographs. Specific written consent to release photographs, separate to release of medical record, is needed to release photographs to law enforcement.
• All hospitals should consult with their legal counsel to establish policies and procedures for sexual assault patient forensic photography regarding consent, storage, and release.

Reimbursement for Services Provided to Sexual Assault Patients:

New York State law provides for direct reimbursement to providers of forensic health care examination services. Reimbursement provides for the personal privacy of sexual assault patients and ensures that survivors are not billed for any forensic health care examination services, including a seven-day starter pack of HIV post-exposure prophylaxis. To obtain a Forensic Rape Examination (FRE) claim application or more information, visit the Office of Victim Services (OVS).

Post Exposure Prophylaxis (PEP):

Forced sexual contact may result in pregnancy or exposure to human immunodeficiency virus (HIV), hepatitis, and sexually transmitted infections (STIs). Proper care should be provided immediately.NYS Clinicians may call the Clinical Education Initiative (CEI) Clinician Phone Line 866-637-2342 to consult with a specialist about clinical inquiries on HIV, Sexual Health, Hepatitis C and Drug User Health. Or visit the CEI website here

• Pregnancy: For female patients of child-bearing age or female to male transgender patients who still have the anatomical features of a female, there is a risk of pregnancy from rape. Examiners are expected to adhere to and fully document services provided, consistent with the following standards of professional practice and Public Health Law 2805-p:
  • Counsel rape patients about options for emergency contraception (EC) against pregnancy and the importance of timely action.
  • Provide rape patients with written information prepared or approved by the Department relating to EC.
    • Emergency Contraception: What you Need to Know (English)
    • Emergency Contraception: What you Need to Know (Spanish)
    • I Might Have Been Exposed to HIV… What Should I Do?
    • HIV and AIDS Facts (English)
    • HIV and AIDS Facts (Spanish)

    Care for Suspected Child Abuse Patients:

    Most sexually abused children who do not present with emergent medical conditions can be scheduled with an appointment at a Child Advocacy Center (CAC) or with a medical provider. However, all children who are suspected of being sexually abused should have the opportunity for a medical evaluation and timely collection of forensic evidence by a Child Abuse Medical Provider (CHAMP), SAFE-P, certified child abuse pediatrician, or a pediatric examiner.

    • If there is reasonable cause to suspect a child has been sexually abused or maltreated by a parent, guardian, custodian, or other person over the age of 18 legally responsible for the child, a report must be called into 1-800-342-3720.For more information, please visit OCFS Child Protective Services.
    • CHAMP is a statewide network of medical providers specially trained to examine pediatric patients suspected of being sexually abuse. The CHAMP Program offers education to eligible pediatric practitioners to become CHAMP members and continuing internet-based education. To find out more, visit their website here.
    • CAC's specialize in child sexual abuse by building upon a multidisciplinary team approach to provide investigations, evaluations, treatment and prosecution services for child sexual abuse patients. For more information, visit New York State Children's Alliance here.

    For additional guidance on pediatric sexual assault patients, refer to the U.S. Department of Justice Office on Violence Against Women's A National Protocol for Sexual Assault Medical Forensic Examinations Pediatric".

    Rape Crisis or Victim Assistance Advocate:

    The DOH has established standards for rape crisis programs to train rape crisis or victim assistance advocates. Advocates who complete the training can, by law, provide confidential services to sexual assault patients. Hospital personnel shall advise sexual assault patients of the availability of services from a local rape crisis program, if any, to accompany the patient through the medical-forensic exam. If the patient wishes the presence of an advocate, the hospital shall contact the appropriate organization and request that one be provided.

    Sexual Assault Response Team (SART):

    A goal of the DOH's SAFE Program is to utilize an interdisciplinary approach by working with the local rape crisis program, law enforcement, prosecutors, hospitals, and other necessary service providers to effectively meet the needs of the sexual assault victim and the community. SARTs help to achieve this goal by bringing parties together on a regular basis. For more information please visit the Office of Justice Programs SART Toolkit.

    Department of Health SAFE Program Contact Information:

    • New York State Department of Health, Division of Family Health
      Bureau of Perinatal, Reproductive, and Sexual Health
      Empire State Plaza - Corning Tower, Room 821
      Albany, New York 12237
      (518)-474-0535
      SVPrevention@health.ny.gov*

    * Note: This shared mailbox is only monitored by Sexual Violence Prevention Program staff from 8:00 am to 5:00 pm Monday through Friday and is intended for non-emergency purposes. If you are someone who has been sexually assaulted and you are seeking immediate assistance, please contact the New York State Hotline for Sexual Assault and Domestic Violence at 1-800-942-6906. If it is an emergency, contact 911.

    Relevant Laws and Regulations

    • New York Public Health Law 2805-i – Treatment of Sexual Offense Victims and Maintenance of Evidence in a Sexual Offense
    • New York Public Health Law 2805-p – Emergency Treatment of Rape Survivors
    • New York Public Health Law 2803-d -- Reporting Abuses of Persons Receiving Care or Services in Residential Health Care Facilities
    • New York Public Health Law 2805-y - Identification and assessment of human trafficking victims
    • New York Executive Law 631 (13) – Awards
    • New York Penal Law 265.25 – Certain Wounds to be Reported
    • New York Penal Law 265.26 – Burn Injury and Wounds to be Reported
    • New York Penal Law 130.05 – Sex Offenses; Lack of Consent
    • 10 New York Codes, Rules, and Regulations 722 – Sexual Assault Forensic Examiner (SAFE) Programs
    • 10 New York Codes, Rules, and Regulations 405.19(c) – Emergency Services
    • 10 New York Codes, Rules, and Regulations 405.9(c) – Administration/ Discharge
    • 10 New York Codes, Rules, and Regulations 69-5 – Approval of Rape Crisis Programs for the Purpose of Rape Crisis Counselor Certification

    Online Resources

    New York State Organizations:

    • New York State Coalition Against Sexual Assault
    • New York City Alliance Against Sexual Assault
    • New York State Department of Health AIDS Institute
    • Clinical Education Initiative (CEI)
    • New York State Division of Criminal Justice Services: Office of Forensic Services
    • New York State Division of Criminal Justice Services: Sexual Offense Evidence Kits
    • New York State Office of Victim Services
    • State University of New York: Sexual Assault and Violence Response Resources
    • New York State Trauma-Informed Network
    • TeleSAFE

    National Organizations

    • International Association of Forensic Nurses
    • National Center for Victims of Crime
    • Rape, Abuse & Incest National Network
    • National Sexual Violence Resource Center
    • Office for Victims of Crime
    • RHIhub National TeleNursing Center

    Department of Health Guidance Letters

    • 2023 Runaway and Homeless Youth Dear Provider Letter
      • Runaway and Homeless Youth FAQ

      Tools and Guidance Documents:

      • DCJS Training for medical providers
      • Adolescent Consent to HIV and STI Treatment
      • A National Protocol for Sexual Assault Medical Forensic Examinations Adult/Adolescents
      • A National Protocol for Sexual Assault Medical Forensic Examinations Pediatric
      • An Overview of Minors' Consent Law
      • Biological Evidence Preservation Handbook: Best Practices for Evidence Handlers
      • Emergency Contraception: What you need to know (available in English and Spanish)
      • Human Trafficking Guidebook on Identification, Assessment, and Response in the Health Care Setting
      • National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach
      • Non-Fatal Strangulation Documentation Toolkit
      • Responding to Transgender Victims of Sexual Assault
      • Rights of Crime Victims in New York State
      • SANE Program Development and Operation Guide
      • SART Toolkit
      • Sexual Assault Response Team Development Guide for Victim Service Providers