77 Ill. Adm. Code 545.60
Treatment of Sexual Assault Survivors
Section 545
Section 545.60Â Treatment of
Sexual Assault Survivors
a)
Every hospital and approved pediatric health care facility providing
medical forensic services to sexual assault survivors shall
comply with the
federal Emergency Medical Treatment and Active Labor Act and,
as minimum
requirements for such services, provide, with the consent of the sexual assault
survivor, and as ordered by the attending physician, an APRN
who possesses
clinical privileges recommended by the hospital or approved pediatric health
care facility medical staff and granted by the hospital or approved pediatric
health care facility, as authorized by the Nurse Practice Act,
or a
physician assistant, the services set forth in Section 5(a-5)
of the Act
and this Section. (Section 5(a) of the Act)
b)Â Â Â Â Â Â Â Â A
qualified medical provider shall provide the services set
forth in Section 5(a-5) of the Act,
and this Section. (Section 5(a) of the
Act)
c)Â Â Â Â Â Â Â Â Every
hospital with a treatment plan approved by the
Department shall employ or contract with a qualified medical provider to
initiate medical forensic services to a sexual assault survivor within 90
minutes after the patient presenting to the treatment hospital or treatment
hospital with approved pediatric transfer. The provision of medical forensic
services by a qualified medical provider shall not delay the provision of
life-saving medical care
. (Section 5(a-7) of the Act)
d)
A treatment hospital, a treatment hospital with approved
pediatric transfer or an approved pediatric health care facility shall provide
the following services in accordance with Section 5(a)
of the Act
:
1)
Appropriate medical forensic services without delay, in a
private, age-appropriate or developmentally appropriate space, required to
ensure the health, safety, and welfare of a sexual assault survivor and that
may be used as evidence in a criminal proceeding against a person accused of
the sexual assault, in a proceeding under the Juvenile Court Act of 1987, or in
an investigation under the Abused and Neglected Child Reporting Act.
(Section 5(a-5) of the Act) Medical forensic services shall include, but are not
limited to:
A)Â Â Â Â Â Â Â A general physical examination;
B)Â Â Â Â Â Â Â Evaluation and treatment for sexually transmitted infections in
accordance with the guidelines of the Centers for Disease Control and Prevention
titled Sexually Transmitted Diseases Treatment Guidelines, or the standards of
the American College of Emergency Physicians titled Management of the Patient
with the Complaint of Sexual Assault (see Section 545.25);
C)Â Â Â Â Â Â Â Evaluation and possible treatment for HIV exposure in
accordance with the guidelines of the Centers for Disease Control and
Prevention titled Sexually Transmitted Diseases Treatment Guidelines, or the
recommendations titled Antiretroviral Postexposure Prophylaxis After Sexual,
Injection Drug Use, or Other Nonoccupational Exposure to HIV in the United
States, or the standards of the American College of Emergency Physicians titled
Management of the Patient with the Complaint of Sexual Assault. Testing for HIV
shall be conducted in accordance with the AIDS Confidentiality Act; and
D)Â Â Â Â Â Â Â Pregnancy test for females of childbearing age;
2)
An offer to complete the Sexual Assault Evidence Collection
Kit for any sexual assault survivor who presents within seven days after the
assault
,
who has disclosed past sexual assault by a specific individual
and was in the care of that individual within the last seven days
, or who
has a clinical indication for medical forensic services beyond seven days.Â
Nothing in the Act or this Part prevents a treatment hospital or a treatment
hospital with approved pediatric transfer from offering to complete the Sexual
Assault Evidence Collection Kit for any sexual assault survivor who presents
more than seven days after the assault;
A)
Appropriate oral and written information concerning
evidence-based guidelines for the appropriateness of evidence collection,
depending on the sexual development of the sexual assault survivor, the type of
sexual assault, and the timing of the sexual assault, shall be provided to the
sexual assault survivor.
A qualified medical provider shall educate and encourage
prepubescent sexual assault survivors who present to a hospital or approved
pediatric health care facility with a complaint of sexual assault within 96
hours after the sexual assault
to agree to evidence collection (however,
the seven-day period in subsection (d)(2) still applies)
;
B)Â Â Â Â Â Â Â The
information required under this
subsection (d)
shall be provided in person by the qualified medical provider providing medical
forensic services directly to the sexual assault survivor
(Section 5(a-5)
of the Act)
;
C)
The written information provided shall be the information
created in accordance with Section 10 of the Act
(Section 5(a-5) of the
Act)
;
D)
Following the discussion regarding the evidence-based
guidelines for evidence collection in accordance with
subsection (d)(2)(A)
,
evidence collection shall be completed at the sexual assault survivor's
request. A sexual assault nurse examiner conducting an examination using the
Sexual Assault Evidence Collection Kit may do so without the presence or
participation of a physician.
(Section 5(a-5) of the Act)
3)
Appropriate oral and written information concerning the
possibility of infection, sexually transmitted infection, including an
evaluation of the sexual assault survivor's risk of contracting human
immunodeficiency virus (HIV) from sexual assault, and pregnancy resulting from
sexual assault
(Section 5(a-5) of the Act);
4)
Medically and factually accurate written and oral
information about emergency contraception; the indications and contraindications
and risks associated with the use of emergency contraception; and a description
of how and when
sexual assault survivors
may be provided emergency
contraception at no cost upon the written order of a physician, a licensed APRN,
or a licensed physician assistant
(Section 2.2(b) of the Act);
5)
Appropriate oral and written information concerning
accepted medical procedures, laboratory tests, medication, and possible
contraindications of that medication available for the prevention or treatment
of infection or disease resulting from sexual assault
(Section 5(a-5) of
the Act);
6)
After a medical
forensic
or physical examination,
access to a shower at no cost, unless showering facilities are unavailable
(Section 5(a-5) of the Act);
7)
An amount of medication, including HIV prophylaxis, for treatment
at the hospital or approved pediatric health care facility and after discharge
as is deemed appropriate by the attending physician, an APRN, or a physician
assistant in accordance with the Centers for Disease Control and Prevention
guidelines
in Section 545.25(b)(1) and (2),
and consistent with the
hospital's or approved pediatric health care facility's current approved
protocol for sexual assault survivors.
(Section 5(a-5) of the Act) When HIV
prophylaxis is deemed appropriate, an initial dose or doses of HIV prophylaxis,
along with written and oral instructions indicating the importance of timely
follow-up health care, shall be given to the survivor;
8)
Photo documentation of the sexual assault survivor's
injuries, anatomy involved in the assault, or other visible evidence on the
sexual assault survivor's body to supplement the medical forensic history and
written documentation of physical findings and evidence. Photo documentation
does not replace written documentation of the injury.
(Section 5(a-5) of
the Act);
9)
Written and oral instructions indicating the need for follow-up
examinations and laboratory tests
one to two weeks
after the sexual
assault
to determine the presence or absence of sexually transmitted infection
(Section 5(a-5) of the Act);
10)       Appropriate referral to a physician. The survivor shall be
referred for follow-up health care and monitoring of medication given or
prescribed at the time of the initial hospital or approved pediatric health
care facility medical forensic services visit as may be deemed appropriate by
the attending physician, APRN, or physician assistant;
11)
Referral by hospital or approved pediatric health care
facility personnel for appropriate counseling
. (Section 5(a-5) of the Act) Initial
referral should be to a community-based rape crisis center, if a center is
available, or referral to other counseling shall be provided;
12)
Medical advocacy services provided by a rape crisis
counselor whose communications are protected under Section 8-802.1 of the Code
of Civil Procedure, if there is a memorandum of understanding between the
hospital or approved pediatric health care facility and a rape crisis center.
With the consent of the sexual assault survivor, a rape crisis counselor shall
remain in the exam room during the medical forensic examination
(Section
5(a-5) of the Act)
;
13)
Written information regarding services provided by a
children's advocacy center and rape crisis center, if applicable
(Section
5(a-5) of the Act)
;
14)Â Â Â Â Â Â Â The brochure "After Sexual Assault", published by
the Illinois Coalition Against Sexual Assault and the Illinois Department of
Public Health, and the pamphlet "Crime Victim Compensation – Frequently
Asked Questions by Sexual Assault Victims", published by the Illinois
Office of the Attorney General;
15)Â Â Â Â Â Â Â Information on drug- or alcohol-facilitated sexual assault
testing, including an explanation of the comprehensive scope of a drug test or
blood alcohol test, and the limited time frame within which evidence can be
collected; and
16)
Written information regarding the Illinois State Police
sexual assault evidence tracking
system, as provided in Section 545.61.Â
(Section 5(a-5) of the Act)
e)
Records of medical forensic services, including results of
examinations and tests, the Illinois State Police Medical Forensic
Documentation Forms, the Illinois State Police Patient Discharge Materials, and
the Illinois State Police Patient Consent: Collect and Test Evidence or Collect
and Hold Evidence Form, shall be maintained by the hospital or approved
pediatric health care facility as part of the patient's electronic medical
record.
1)
Records of medical forensic services for sexual assault
survivors under the age of 18 shall be retained by the hospital or
approved
pediatric health care facility
for a period of 60 years after the sexual
assault survivor reaches the age of 18. Records of medical forensic services of
sexual assault survivors 18 years of age or older shall be retained by the
hospital for a period of 20 years after the date the record was created.
2)
Records of medical forensic services may only be
disseminated in accordance with Section 6.5 of the Act
, Section 545.61 of
this Part,
and other State and federal law.
(Section 5(a-5) of the Act)
f)
Any
person who is a sexual assault survivor who seeks medical forensic services or
follow-up healthcare under
the
Act shall be provided those
services without the consent of any parent, guardian, custodian, surrogate, or
agent.
If a sexual assault survivor is unable to consent to medical
forensic services, the services may be provided under the Consent by Minors to Health
Care Services Act, the Health Care Surrogate Act, or other applicable State and
federal laws.
(Section 5(b) of the Act)
g)Â Â Â Â Â Â Â Â The hospital or approved pediatric health care facility shall
develop a
uniform system for recording results of medical examinations and
all diagnostic tests performed in connection
with the examination
to
determine the condition and necessary treatment of sexual assault survivors.
The
results shall be preserved in a confidential manner as part of the hospital's
or approved pediatric health care facility's record of the sexual assault
survivor.
(Section 6.1 of the Act) The medical record shall include the
information required in this subsection (g):
1)Â Â Â Â Â Â Â Â The medical record shall indicate if the sexual assault
survivor changed clothes, bathed or douched, defecated, urinated, ate, smoked,
or performed oral hygiene between the time of the sexual assault and the time
of the examination.
2)Â Â Â Â Â Â Â Â The medical record shall indicate presence of all indications
of trauma, major or minor, that may be used in a criminal proceeding (e.g.,
cuts, scratches, bruises, red marks, any minor signs of trauma). Photographs
of indications of trauma may be taken for evidentiary purposes with the written
consent of the sexual assault survivor or the survivor's parent or guardian if
the survivor is under 13 years of age. If the survivor is under 13 years of
age and the parent or guardian is not immediately available, photographs may be
taken and shall be released to law enforcement personnel and state's attorney
staff with written consent of a parent, guardian, or law enforcement officer,
or the Department of Children and Family Services.
3)Â Â Â Â Â Â Â Â The medical record shall not reflect any conclusions regarding
whether a crime (e.g., criminal sexual assault, criminal sexual abuse)
occurred.
4)Â Â Â Â Â Â Â Â Medical history shall include brief, general information
concerning possible injury; drug allergies; and, for female patients, a
detailed gynecological history, including whether the patient knows or believes
that she is pregnant, history of prior gynecological surgery such as
hysterectomy or tubal ligation, history of contraceptive use, history of cancer,
and any prior genital injury or trauma.
5)Â Â Â Â Â Â Â Â The medical record shall indicate the presence of any and all
persons during the examination process. If a medical advocate from a rape
crisis center is present, the medical advocate may be listed by first name
only, so long as the full name of the rape crisis center is listed in the
record.
6)Â Â Â Â Â Â Â Â The medical record shall document the compliance with each
procedure required by subsection (i).
7)Â Â Â Â Â Â Â Â The medical record shall indicate whether a report was filed
with the Department of Children and Family Services, or whether the Department
on Aging or the Department of Public Health was contacted.
8)Â Â Â Â Â Â Â Â The medical record shall include a completed emergency department
record.
9)Â Â Â Â Â Â Â Â The medical record shall indicate whether the Sexual Assault
Evidence Collection Kit was completed.
h)Â Â Â Â Â Â Â Â All medical records for sexual assault survivors shall be
maintained through a filing system that allows for immediate accessibility
during Department surveys. This filing system may be maintained electronically.
i)Â Â Â Â Â Â Â Â Â Procedures to ensure the welfare and privacy of the survivor
shall be followed and shall include, but not be limited to, the following:
1)Â Â Â Â Â Â Â Â A member of the health care team shall respond within minutes
to move the survivor to a closed environment to ensure privacy. Health care personnel
shall refer to survivors by code to avoid embarrassment.
2)Â Â Â Â Â Â Â Â If, for any reason, the survivor is incapable of receiving
oral and written information required in subsection (a), the information shall
be given to the caregiver/guardian.
3)Â Â Â Â Â Â Â Â When a survivor is in custody, or has been arrested for or
convicted of a violent crime or forcible felony and continues to be in custody
when the survivor presents for the medical forensic exam, then if the qualified
medical provider and the representative of the custodial agency, after
consultation with the rape crisis advocate, agree that it is a necessary safety
precaution, the representative of the custodial agency may remain in the room.
In these situations, hospital staff shall facilitate privacy for the survivor
using curtains and positioning.
4)Â Â Â Â Â Â Â Â The hospital or approved pediatric health care facility shall
call a sexual assault crisis advocate, where available, and shall offer to call
a friend or family member to accompany the survivor.
j)
When a minor is the victim of a predatory criminal sexual
assault of a child, aggravated criminal sexual assault, criminal sexual
assault, aggravated criminal sexual abuse or criminal sexual abuse, as provided
in Sections 11-1.20 through 11-1.60 of the Criminal Code of 2012, the consent
of the minor's parent or legal guardian need not be obtained to authorize a
hospital
, approved pediatric health care facility
, physician, chiropractic
physician, optometrist, APRN, physician assistant, or other medical personnel
to furnish medical care or counseling related to the diagnosis or treatment of
any disease or injury arising from the offense. The minor may consent to
counseling, diagnosis or treatment as if the minor had reached his or her age
of majority. This consent shall not be voidable, nor subject to later
disaffirmance, because of minority.
(Section 3(b) of the Consent by Minors
to Health Care Services Act)
k)Â Â Â Â Â Â Â Â All hospitals or approved pediatric health care facilities that
provide emergency medical services to sexual assault survivors shall comply
with the Crime Victims Compensation Act, the Consent by Minors to Health Care Services
Act and any local ordinances, municipal codes, rules, or regulations that may
apply to the treatment of sexual assault survivors.
l)Â Â Â Â Â Â Â Â Â All hospitals or approved pediatric health care facilities shall
comply with the reporting procedures for sexual assault survivors required by
Section 3.2 of the Criminal Identification Act.
m)
Nothing in this Section creates a physician-patient
relationship that extends beyond discharge from the hospital or approved
pediatric health care facility.
(Section 5(c) of the Act)
n)Â Â Â Â Â Â Â Â The hospital or approved pediatric health care facility shall
take all reasonable steps to secure the patient's informed written decision to consent
to or decline examination and treatment.
o)Â Â Â Â Â Â Â Â Nothing in the Act or this Part prohibits a treatment
hospital, a treatment hospital with approved pediatric transfer, or an approved
pediatric health care facility from treating a sexual assault survivor who
presents more than seven days following the assault.