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Sexual Assault Transfer Plan Form

Sexual Assault Transfer Plan Form 2025

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The Sexual Assault Transfer Plan Form outlines the requirements for hospitals in Illinois to create a transfer plan for sexual assault survivors, ensuring compliance with federal and state regulations. It includes sections for hospital information, procedures for privacy and support, treatment timelines, and conditions of approval for providing services. The form emphasizes the importance of maintaining medical records and outlines billing procedures to ensure that survivors receive necessary care without direct charges.

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Click ‘Get Form’ to open the Sexual Assault Transfer Plan Form in the editor.
Begin by filling out Part A, which includes the name and mailing address of the transfer hospital. Ensure you provide accurate contact information for both the program and billing representatives.
Next, indicate the number of adult, adolescent, and pediatric sexual assault survivors transferred in the previous year, as well as your estimates for the upcoming fiscal year.
In Part B, describe procedures ensuring privacy and support for survivors. Attach any necessary documents as required by regulations.
Complete Part C by reviewing and signing the Conditions of Approval. Make sure all conditions are understood and agreed upon before submission.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What reporting option occurs when the victim reports the sexual assault to their chain of command?

What is an Unrestricted Report? Filing an Unrestricted Report will result in an investigation into the sexual assault and the chain of command will be notified. You can also request additional protective and support measures like Expedited Transfers or Military Protective Orders.

Which reporting option is suitable for victims who would like to access resources?

There are two types of reporting options for adult victims of sexual assault: restricted and Unrestricted. Compliance with the procedures detailed in AR 600-52, Chapter 3 is mandatory. (2) When the victim previously filed an Unrestricted Report with a signed DD Form 2910 for the same sexual assault.

What does a sexual assault response coordinator do?

The SARC coordinates on-base resources, such as chaplains and medical treatment facilities, to meet victim needs. Prepares for visits from inspecting authorities and criminal investigation authorities. Performs other duties as assigned.

What are the two reporting options for victims of sexual assault?

You can make an Unrestricted Report to a SARC, VA, law enforcement official, a commander, or health care personnel. Filing a Restricted Report allows you to confidentially disclose a sexual assault to a SARC or VA without notifying your command or law enforcement.

What steps are you required to take to preserve the evidence of a sexual assault victim?

The following steps will help to preserve evidence of a or other sexual assault: Do not shower or douche. Try not to urinate. If there was oral contact, do not smoke, eat, or brush your teeth. Do not change clothes.

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What are the two types of sexual assault reporting options for Army soldiers?

I Want to File a Sexual Assault Report. Soldiers have two reporting options: Restricted and Unrestricted. An Unrestricted Report will prompt an official investigation. A Restricted Report will not prompt an official investigation unless the victim discloses the information to a mandatory reporter.

What were you wearing exhibit?

The What Were You Wearing exhibit is an installation answering the question frequently asked of survivors. This exhibit features narratives and re-creations of outfits based on survivors experiences.

Sexual Assault Transfer Plan Form 2025

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Got questions?

What reporting option occurs when the victim reports the sexual assault to their chain of command?

Which reporting option is suitable for victims who would like to access resources?

What does a sexual assault response coordinator do?

What are the two reporting options for victims of sexual assault?

What steps are you required to take to preserve the evidence of a sexual assault victim?

Complete this form in 5 minutes or less

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What are the two types of sexual assault reporting options for Army soldiers?

What were you wearing exhibit?

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