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Health care providers are not immune to IPV. Any of the resources and materials on this website can be used by health care providers who are affected by intimate partner violence. To view an important exhibit about health care providers as survivors of IPV developed by Kaiser Permanente, please click here.

Mandatory Reporting

Safety Planning
  • A two-sided safety plan that can be used with victims and survivors of family and intimate partner violence. This planning tool describes safety measures to take while both in an abusive relationship and after leaving an abusive relationship. It includes a personalized safety plan that you can fill out with your patients.
  • Exit Instructions:
    Safety instructions to give to patients who are being victimized. Click on whichever language you would like to print. (The resource phone numbers are in English, translations pending.)
    NOTE: You must change the phone numbers on page 2 of each of these exit instructions if you are not practicing in San Francisco.
    english | spanish | chinese | tagalog | russian | serbian | arabic

    Creating a Safe Space for Disclosure of IPV

  • Posters:
    Posters are essential. Even if patients don't feel comfortable disclosing IPV on site, they can use hotline numbers on posters to get help. You can     order posters from the Family Violence Prevention Fund.
    If you live in San Francisco, you can download this San Francisco-specific exam room door poster.
  • Brochures for Pregnant Patients:
    Download copies of these brochures on pregnancy and IPV for each of your pregnant patients. The brochure helps patients understand the effects of IPV on pregnant women and their children and also list resources for victims of IPV.
    English color, black+white | Spanish | Tagalog | Russian | Chinese (To be released soon)
  • Safety Cards:
    Place these wallet-sized cards in bathrooms, exam rooms, and waiting rooms. Cards are available for both victims/survivors and perpetrators in various languages. You can order preprinted cards directly from the Family Violence Prevention Fund or print cards conveniently from this site.

    Documentation

  • Chart Stamp:
    Busy providers will not remember to screen for IPV without written prompts. Stamp your problem list with a prompt     screening stamp. (see here for an example of how to use this screening stamp.
  • Body/Face maps:
    face map, body map
  • Collecting Evidence:
    A form that may be used in any setting to have a patient consent to evidence collection.
  • Photo documentation:
    -    Guidelines and tips for taking photographs for evidence collection.
    -Consent for Photography form for patient consent.

    		• QUICK LINKS
  • Quick Screening Tool
  • IPV Hotlines
  • Safety Planning
  • Mandatory Reporting

    PROVIDER FORMS
  • Posters
  • Brochures for Pregnant Women
  • Safety Cards
  • Chart Stamps
  • Body Maps
  • Collecting Evidence
  • Photo documentation
  • Exit Instructions








    • SITE INDEX

    NATIONAL DOMESTIC VIOLENCE HOTLINE: 1-800-799-7233

    CONTACT INFO

    LEAP strives to improve the health care response to intimate partner violence.