ANNEX IV Guidelines for the medical evaluation of torture and ill-treatment The following guidelines are based on the Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. These guidelines are not intended to be a fixed prescription, but should be applied taking into account the purpose of the evaluation and after an assessment of available resources. Evaluation of physical and psychological evidence of torture and ill-treatment may be conducted by one or more clinicians, depending on their qualifications. I. Case information Date of exam: Exam requested by (name/position): Case or report No.: Duration of evaluation: Subject’s given name: Birth date: Birth place: Subject’s family name: Gender: male/female: Reason for exam: Subject’s ID No.: Clinician’s name: Informed consent: yes/no hours, Interpreter (yes/no), name: If no informed consent, why?: Subject accompanied by (name/position): Persons present during exam (name/position): Subject restrained during exam: yes/no; If “yes”, how/why? Medical report transferred to (name/position/ID No.): Transfer date: Transfer time: Medical evaluation/investigation conducted without restriction (for subjects in custody): yes/no Provide details of any restrictions: II. Clinician’s qualifications (for judicial testimony) Medical education and clinical training Psychological/psychiatric training Experience in documenting evidence of torture and ill-treatment Regional human rights expertise relevant to the investigation Relevant publications, presentations and training courses Curriculum vitae. 73 minutes