Sexual Assault Evidence Kit (SAEK) Forms

• Fillable – examiner and patient digital signature
• Fillable – examiner digital signature
• Fillable – no digital signature

Texas Department Of Health And Human Services Information Sheet For Sexual Assault Patients

Health care providers are mandated to give patients the Information Sheet for Sexual Assault Patients, available in Spanish and English.

• Information for Survivors of Sexual Assault – SAFE-Ready Facility – (PDF in English)
• Information for Survivors of Sexual Assault – SAFE-Ready Facility – (PDF in Spanish)

If a facility is not “SAFE-ready,” health care providers are required to give sexual assault patients the following form (Texas Health and Human Services, 2018).

• Information for Survivors of Sexual Assault – Non-SAFE-Ready Facility – (PDF in English)
• Information for Survivors of Sexual Assault – Non-SAFE-Ready Facility – (PDF in Spanish)