Questions | Concepts |
|---|---|
Screening Date ␣␣-␣␣-␣␣␣␣ 📆 | |
Within the past year, has someone ever hit, kicked, slapped, or otherwise physically hurt you? 🔘 Yes 🔘 No | |
Has someone ever threatened to hurt you? 🔘 Yes 🔘 No | bd86f7ee-1d5f-4f5d-aa0f-4680aa6e65cb |
Has someone ever forced you to do something sexually that made you feel uncomfortable? 🔘 Yes 🔘 No | |
By who? ☑️ Partner or spouse ☑️ Unknown Person | |
Intimate Partner Violent Notes |
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