Sexual Assault Exams

Sexual Assault Medical Examination Payment Program (Providers ONLY)

No bill for the examination will be submitted to the victim, nor shall the medical facility hold the victim responsible for payment. (Section 99-37-25 of the Mississippi Code Annotated) The hospital/clinic is responsible for submitting to the Office of the Attorney General’s Victim Compensation Division a copy of the exam form and the bill for payment consideration. Hospitals/clinics should refer to the payment policy link below for more information. For further information, please call 1-800-829-6766.

Sexual Assault Exam Payment Policy updated Oct. 1 2015


MS Crime Lab Sexual Assault Evidence Collection Kits

All State of Mississippi Crime Lab Sexual Assault Evidence Collection Kits include a Sexual Assault Exam form. The Child/Adolescent Examination Form, the Adolescent/Adult Examination Form and the Non-Acute 72 Hours Child/Adolescent Examination Form can be viewed and/or downloaded by clicking the links below.

Child Adolescent Examination Form

Adolescent Adult Examination Form

NonAcute 72 Hours Child Adolescent Examination Form