III. Statement regarding veracity of testimony (for judicial testimony) For example: “I personally know the facts stated below, except those stated on information and belief, which I believe to be true. I would be prepared to testify to the above statements based on my personal knowledge and belief.” IV. Background information General information (age, occupation, education, family composition, etc.) Past medical history Review of prior medical evaluations of torture and ill-treatment Psychosocial history pre-arrest. V. Allegations of torture and ill-treatment 11. 12. 13. 14. 15. VI. Summary of detention and abuse Circumstances of arrest and detention Initial and subsequent places of detention (chronology, transportation and detention conditions) Narrative account of ill-treatment or torture (in each place of detention) Review of torture methods. Physical symptoms and disabilities Describe the development of acute and chronic symptoms and disabilities and the subsequent healing processes. 11. Acute symptoms and disabilities 12. Chronic symptoms and disabilities. VII. 11. 12. 13. 14. 15. 16. 17. 18. 19. VIII. 11. 12. 13. 14. 15. 16. 17. 18. 19. 10. Physical examination General appearance Skin Face and head Eyes, ears, nose and throat Oral cavity and teeth Chest and abdomen (including vital signs) Genito-urinary system Musculoskeletal system Central and peripheral nervous system. Psychological history/examination Methods of assessment Current psychological complaints Post-torture history Pre-torture history Past psychological/psychiatric history Substance use and abuse history Mental status examination Assessment of social functioning Psychological testing: (see chapter VI, sect. C.1, for indications and limitations) Neuropsychological testing (see chapter VI, sect. C.4, for indications and limitations). 74