# COMAR Title 10 — Maryland Department of Health

## Subtitle 27 — Board of Nursing

### Chapter 21 — Registered Nurse — Forensic Nurse Examiner

#### Regulation .04 Scope and Standards of Practice.

*COMAR 10.27.21.04*

A. An RN-FNE may perform the following tasks and functions with respect to the age group for which the RN-FNE is certified under Regulation .03 of this chapter:

  (1) Perform forensic evidentiary examinations on victims and alleged perpetrators in connection with physical, sexual, or domestic assaults, whether chronic or acute;

  (2) Before the forensic evidentiary examination, obtain consent from the individual being examined, from the parent or guardian of a minor individual, or from the proper authority for photographing and evidence collection;

  (3) Prepare and document the assault history interview;

  (4) Perform the forensic evidentiary physical assessment, which may include use of an ALS;

  (5) Complete the physical evidence kit provided by law enforcement;

  (6) Gather, preserve, handle, document, and label forensic evidence, including but not limited to:

    (a) Labeling evidence collection containers with the patient's identifying data per local jurisdiction requirements;

    (b) Placing evidence in the evidence collection container and sealing the container;

    (c) Signing the evidence collection container as the collector of the evidence;

    (d) Taking photographs; and

    (e) Obtaining swabs, smears, and hair and body fluid samples;

  (7) Maintain the chain of custody;

  (8) Provide immediate health interventions using clinical practice guidelines;

  (9) Obtain consultations and make referrals to health care personnel and community agencies;

  (10) Provide immediate crisis intervention at the time of the examination;

  (11) Provide discharge instructions;

  (12) Participate in forensic proceedings including courtroom testimony;

  (13) Interface with law enforcement officials, crime labs, and State attorney's offices; and

  (14) Assist the licensed physician in performing a forensic evidentiary examination.

B. Clinical Practice Guidelines. An RN-FNE may practice only in a clinical setting in which clinical policy and practice guidelines:

  (1) Have been approved by the facility's medical and nursing departments;

  (2) Designate the availability of qualified physician resources;

  (3) Identify the department in which an RN-FNE shall function; and

  (4) Designate a program coordinator who has experience in forensic evidentiary examinations to administer the RN-FNE training program.

C. The program coordinator:

  (1) Is responsible for obtaining Board approval of the curriculum before conducting a training program;

  (2) Has responsibility for oversight and administration of the facility’s RN-FNE training program and the practice of the facility’s RN-FNEs;

  (3) Verifies the qualifications and certifications of any RN-FNE practicing in the facility;

  (4) Administers and manages the RN-FNE practice;

  (5) Approves practice protocols and standards of care for RN-FNE practice;

  (6) Shall develop a peer review process that includes, but is not limited to:

    (a) Coordinating the peer review of cases;

    (b) Ensuring that the peer review is consistent with the standardized data collection process;

    (c) Ensuring that a peer reviewer meets the qualifications in Regulation .05 of this chapter; and

    (d) Using the standardized form for peer review that is required by the Board;

  (7) Interfaces with law enforcement, the State's attorney, and community resource groups;

  (8) Implements the facility's Board-approved RN-FNE curricula; and

  (9) Facilitates reimbursement for RN-FNE services by cooperating with the facility's billing department and interacting with the State reimbursement system.

D. An RN-FNE shall comply with all State and federal statutes and regulations related to the RN-FNE practice.

E. An RN-FNE shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.