TPF Medical Form ( PF3)

The Tanzania Police Force Medical Examination Report (Form PF 3) is a document used to request and record medical examinations for individuals involved in legal cases. Below are the requirements and details that need to be completed in the form:

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PART I: REQUEST FOR MEDICAL EXAMINATION

(To be completed by the Police Officer requesting the medical examination)

1. Case File Number: The case file number related to the incident.
2. Police Station: The name of the police station where the case is being handled.
3. Recipient: The medical practitioner to whom the request is addressed.
4. Patient Details:

• Name of the person to be examined.
• Age of the person.
• Date of the alleged offence.
• Details of the alleged offence.

1. Requesting Officer:

• Name, signature, and stamp of the police officer requesting the examination.

1. Note: The investigating officer must sign for all specimens or items collected and sealed by the medical practitioner.

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PART II: MEDICAL DETAILS OF THE ALLEGED CASE

(To be completed by the Medical Practitioner)

1. Personal Patient File Number: The patient’s file number at the medical facility.
2. Date and Time: The date and time of the examination.
3. General Information:

• Nature of complaints: Description of the patient’s complaints.
• Estimated age and gender: Estimated age and gender of the person examined.
• General physical/mental examination: Observations on general appearance, bruises, bites, drug/alcohol use, and demeanor.
• General Medical History: Relevant medical history related to the offence.
• Condition and appearance of clothes: Description of the patient’s clothing, including any tears, blood stains, or fluids.
• Guardian’s name and relationship: For minors or mental health cases, the name and relationship of the guardian.

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PART III: ASSAULT, ACCIDENT, AND OTHER CASES

(To be completed by the Medical Practitioner)

1. Approximate age of injuries: Estimated time since the injuries occurred (e.g., hours, days, or weeks).
2. Treatment received prior to examination: Any treatment the patient received before the examination.
3. Description of injuries: Detailed description of the site, situation, shape, and depth of injuries.
4. Type of weapon or object used: Description of the weapon or object used in the assault.
5. Immediate degree of clinical result of the injury:

• Whether the injury amounts to “harm,” “grievous harm,” or “maim” (definitions provided in the form).

1. Details of specimens collected: Information on any specimens collected during the examination.
2. Comments: Additional remarks by the medical practitioner.

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PART IV: SEXUAL ASSAULT CASES

(To be completed by the Medical Practitioner after Parts II & III)

A: General Information

1. Nature of complaints: Description of the patient’s complaints.
2. Estimated age of the person examined: Estimated age of the patient.

B: Female Patients

1. Physical state and injuries to genitalia: Description of injuries to the labia majora, labia minora, vagina, cervix, and anus, with evidence of penetration.
2. Presence of venereal infections or discharge: Note any infections, discharge, or blood from the genitalia/anus.
3. Details of specimens collected: Information on specimens collected, including pubic hairs and blood.

C: Male Patients

1. Physical state and injuries to genitalia: Description of injuries to the genitalia and anus, with evidence of penetration in case of anal intercourse.
2. Presence of venereal infections or discharge: Note any infections or discharge around the anus and penis.
3. Details of specimens collected: Information on specimens collected, including pubic hairs and blood.

Medical Practitioner’s Remarks

• Additional comments or observations by the medical practitioner.

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Final Section

1. Medical Practitioner’s Details:

• Name, qualifications, and registration number.
• Signature and date.

1. Official Stamp: The official stamp of the medical practitioner or facility.

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Key Definitions Provided in the Form

• Harm: Any bodily hurt, disease, or disorder, whether permanent or temporary.
• Grievous Harm: Harm that amounts to maim or dangerous harm, seriously or permanently injures health, or causes permanent disfigurement or injury to any organ, member, or sense.
• Maim: The destruction or permanent disabling of any external or internal organ, member, or sense.

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