THE KENYA POLICE MEDICAL EXAMINATION REPORT Parr I(T be Completed by Police Officer requesting examination) bon RefOB 9 ~-~-=-Hospital/ Dispensary, {if knowa) Date and time of alleged offence. Ar lars, Sent to you/hospital on the, 2 | —~20.L6-under escort of. ~~eaind of your furnishing me with a "port of the nature and extent of bodily ~ injury sustain by him her, ' Date and time reported to police. Bet details of alleged offence.) nS OEE a 1. State of clothing including ‘presence of (ears, stains (wet or dry) Blood, ete, 2 General medical history (including detailsSECTION “B"—To we CompLeteD ww ALL Casts 6¢ ASSAULT, INCLUDING SEXUAL ASSAULTS, AFTER THe COMPLETION OF SecTio# '- Details of site, situation, shape and depth of injuries sustained (a) Head and neck .. 2 Approximate age of injuries (hours, days 3 Probable type of weapons) causing injury Treatment, if any, received prior to examination ome eae 5. “main”, What were the immediate clinical results of the injury sustained oF “grevious harm", *DenniTions — “Harm” means any bodily hurt, “Main” means the deste "Grevious H, \ ‘oF which harm” means any fs likely so 10 i Lor ine or permanenty injures health, ae; HEAL! wunistRyY ul sreogatht District Hospital 3,072. 344 808 p.0, Box 20728- 00202 praia, 172879 pw mbagattinospital-orB walrobl 0 in € i) ‘gat name Dickacdat! peoMINISTRY OF MEDICAL SERVICES Tel: Nairobi 2724712, 2728530 Mbagathi District Hospital Email: medsup@mbagathidh.or ke 9 P.O. Box 20725 Ref No: Nairobi Reason for referral: =a Cluibld wos asgoulted by how spec: 22 ob 12 MAR 2018