TeleSANE Program Forms The TeleSANE Program provides documentation to assist in the creation of a statewide standard care of practice. All of the following documents make-up the patient documentation packet. Patient Discharge Form Form provided to the patient with pertinent information. Sexual Assault Forensic Examination Record Forensic examination documentation record. Downtime Order Set Form Checklist form used to determine patient care needs. Spoke Site Nurse Checklist Checklist for clinicians to ensure they have performed each step of the patient care. Discharge Medication Template Medication prescription template for nPEP medications. Chain of Custody Log Form Documentation form for chain of custody. Sexual Assault Medical Forensic Examination Consent Form Informed Consent Form TeleSANE Chart Tips Checklist to aid in completing a SANE chart. Reimbursement Forms Through the state of Arkansas both patients and facilities are entitled to reimbursement compensation. Application for Crime Victim Compensation (patient) Patient Reimbursement Compensation Form should be provided to each patient. Arkansas Crime Victims Reparations (facility) The facility should submit a reimbursement compensation form for every patient treated. Workflow Charts The TeleSANE Program has created easy to follow workflow charts for many of the step-by-step guidelines when treating sexual assault patients. Adolescent Workflow To be utilized if patient is 17 and under. Consent to Treatment Workflow To be utilized to determine if patient has provided consent to treatment. TeleSANE Consult Workflow Created to aid clinicians in understanding the flow of a consultation call. HepB Unknown Status Workflow Utilized to determine treatment for patients who may have been exposed to HepB. HepB Known Status Workflow Utilized to determine treatment for patients who may have been exposed to HepB. HIV Post-Exposure Prophylaxis Workflow Utilized to determine treatment for HIV prophylaxis. nPEP Needs Assessment Workflow Utilized to determine treatment for HIV prophylaxis. Telecart & Technology Guides Helpful charts, step-by-step guides, and images to help with utilizing the telecart and technology associated with the TeleSANE Program. Accessing a TeleSANE Consult A step-by step guide with images for powering on the cart and tablet to begin a consult. Connecting the Lutech SD 300 Camera A step-by-step guide with images on connecting the camera to the telecart. Spoke Site Start-Up Consultation Call Workflow A step-by-step guide with images on how to start a consultation call request.