Appointments 1 — MUSC Physicians For Human Rights

Licensed Clinicians perform the forensic medical evaluations with the help of a medical student and oversee the student in the affidavit-writing process. To get involved, you must attend a training on forensic medical evaluations for asylum seekers and join our list of trained clinicians.

Title *

Name *

First Name

Last Name

Email *

Gender *

Clients sometimes express a preference for a clinician of a certain gender. We make every effort to accommodate these requests in order to make our clients feel as safe and as comfortable as possible.

Phone *

(###)

###

####

Current Position *

i.e. "Attending Physician"

Department/ Institutional Affiliation *

e.g. "MUSC Department of Emergency Medicine," "MUSC Department of Family Medicine,"

Please select your degree *

MDs please select your specialty *

Have you been trained to conduct forensic medical examinations of asylum seekers by PHR? *

Yes

Please indicate the date your training was completed

YYYY

Please indicate location of your training

What types of evaluations are you comfortable performing? *

Medical evaluation for adults (including evaluation for physical sequelae of trauma and basic psychiatric evaluation)

Medical evaluation for children under age 18

Psychiatric evaluation for adults

Psychiatric evaluation for children under 18

Gynecologic evaluation

Other (please describe at the end of this form)

How many forensic evaluations have you completed to date? *

1-3

3-6

More than 6

Do you speak any languages besides English fluently? If yes, please indicate below *

Yes

Language 1

Fluency in Language 1

Language 2

Fluency in Language 2

Please use this space to tell us anything else that you think we should know about you.

Thank you!

Clinician Intake

MUSC PHR

musc.asylum@gmail.com