This government document is issued by Office of Grants and Research for use in Massachusetts
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https://www.mass.gov/doc/attachment-b-forensic-sexual-assault-medical-examination-contact-form/download?_gl=1*1n7grgx*_ga*MTY2NTg2Nzk5LjE3MzE2NzIwODE.*_ga_MCLPEGW7WM*MTczODY1NjA4Ny4zOC4xLjE3Mzg2NTc5NjAuMC4wLjA.&_ga=2.68440786.277548862.1738656078-166586799.1731672081