# COMAR Title 10 — Maryland Department of Health

## Subtitle 27 — Board of Nursing

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

**Authority:** Health-General Article, §4-403; Health Occupations Article, §§8-205 and 8-312; Annotated Code of Maryland

**Administrative History:** Effective date: December 13, 1999 (26:25 Md. R. 1898)

**Administrative History:** Regulations .01—.08 repealed and new Regulations .01—.08 adopted effective April 28, 2003 (30:8 Md. R. 542)

**Administrative History:** Regulation .05 amended effective September 25, 2006 (33:19 Md. R. 1561)

**Administrative History:** Regulation .07D adopted effective September 25, 2006 (33:19 Md. R. 1561)

**Administrative History:** Chapter revised effective March 19, 2012 (39:5 Md. R. 383)

**Administrative History:** Regulation .02B amended effective February 27, 2017 (44:4 Md. R. 254); September 10, 2018 (45:18 Md. R. 834)

**Administrative History:** Regulation .03 amended effective February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .03B amended effective September 10, 2018 (45:18 Md. R. 834)

**Administrative History:** Regulation .04A, C amended effective February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .04E adopted effective October 13, 2025 (52:20 Md. R. 1002)

**Administrative History:** Regulation .05 amended effective February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .07 amended effective January 18, 2016 (43:1 Md. R. 13); February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .08A amended effective September 10, 2018 (45:18 Md. R. 834)

#### Regulation .01 Exclusion from Regulations.

*COMAR 10.27.21.01*

This chapter is not applicable to and does not restrict or limit:

A. Other health care practitioners who are authorized to perform these duties under the Maryland Health Occupations Article; or

B. A licensed practical or registered nurse from acting as a chaperone during a forensic examination.

#### Regulation .02 Definitions.

*COMAR 10.27.21.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Alternate light source (ALS)” means equipment that produces visible and invisible light at various wave lengths to enhance the visualization of evidence.

  (2) “Board” means the Board of Nursing.

  (3) “Chain of custody” means a written list identifying, without interruption or lapse, every individual having control or possession of specified items or evidence.

  (4) “Chaperone” means an individual who does not perform any part of the forensic examination but is present during the course of that examination.

  (5) “Clinical preceptor” means an RN-FNE educator or physician who has credentials and experience in forensic examinations.

  (6) “Education” means:

    (a) Giving presentations, including mentored clinical presentations;

    (b) Attending conferences or seminars;

    (c) Completing accredited professional computerized or periodical learning modules; and

    (d) Participating in the facility evaluation or audit process.

  (7) “FNE program” means a facility authorized by the Maryland Department of Health to provide forensic nursing services.

  (8) “Forensic evidentiary examination” means an examination for the purpose of gathering, labeling, preserving, and handling evidence that includes, but is not limited to:

    (a) Photographic and written descriptive documentation of the findings;

    (b) A general health and assault history interview; and

    (c) A physical assessment which may include, but is not limited to:

      (i) Skin surface examination;

      (ii) Oral examination;

      (iii) Genital examination;

      (iv) Anal examination; and

      (v) Speculum vaginal examination.

  (9) “Gynecological Urological teaching associate (GUTA)” means an adult who is trained to teach techniques for performing gender-specific physical examination to health care trainees, using self as a demonstration and practice model with emphasis on teaching from the patient perspective.

  (10) “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.

  (11) “Peer review” means a process by which an RN-FNE’s clinical examination and documentation is reviewed by one or more peers who are authorized to perform the duties of an RN-FNE.

  (12) “Physician” means an individual licensed to practice medicine in this State.

  (13) “Practice guideline” means a written documentation that details the standards of care and practice protocols the facility has established to guide the practice of the RN-FNE.

  (14) “Program coordinator” means an RN-FNE designated by the facility to manage and oversee the FNE program.

  (15) “Proper authority” means a representative of law enforcement, adult or child protective services, or the jurisdictional authority for a minor or mentally incapacitated individual.

  (16) “Refresher course” means a curriculum that:

    (a) Includes didactic and clinical education; and

    (b) Meets the practice requirements for reinstatement of certification as an RN-FNE.

  (17) “Registered nurse” means an individual who:

    (a) Is licensed by the Board to practice registered nursing; or

    (b) Has a multistate licensure privilege to practice registered nursing.

  (18) “RN-FNE” means a registered nurse forensic nurse examiner certified by the Board.

  (19) “RN-FNE Educator” means an individual who:

    (a) Has a current:

      (i) License to practice as a registered nurse in Maryland;

      (ii) Multistate licensure privilege to practice registered nursing under the Nurse Licensure Compact; or

      (iii) Certification to practice as an advanced practice registered nurse in Maryland; and

    (b) Is certified under this chapter as a:

      (i) Registered Nurse Forensic Examiner — Adult (RN-FNE-A);

      (ii) Registered Nurse Forensic Examiner — Pediatric (RN-FNE-P); or

      (iii) Registered Nurse Forensic Examiner — Adult and Pediatric (RN-FNE-AP); and

    (c) Is qualified to teach the theoretical and clinical portions of the RN-FNE training program.

  (20) “RN-FNE-A” means a registered nurse certified by the Board to practice as a forensic nurse examiner with respect to forensic examinations performed on adults and individuals 13 years old or older.

  (21) “RN-FNE-P” means a forensic nurse examiner-pediatric who is certified by the Board to practice as a forensic nurse examiner with respect to examinations of children who are younger than 13 years old.

  (22) “RN-FNE-AP” means a registered nurse certified by the Board to practice as a forensic nurse examiner with respect to examinations of individuals of all ages.

  (23) “SAFE” means a registered nurse who was certified by the Board before December 13, 1999, as a sexual assault forensic examiner under this chapter.

  (24) “SANE” means a registered nurse who has successfully completed a program which meets the Sexual Assault Nurse Examiner Standards of Practice established by the International Association of Forensic Nurses.

  (25) “SANE-A” means a forensic nurse examiner certified by the International Association of Forensic Nurses (IAFN) to perform a forensic evidentiary examination on adults and individuals 13 years old or older.

  (26) “SANE-P” means a forensic nurse examiner certified by the IAFN to perform a forensic evidentiary examination on children who are younger than 13 years of age.

  (27) "Simulation” means the utilization of an adult anatomically correct manikin or a GUTA in the performance of a forensic evidentiary examination.

  (28) “Training program” means the instructional process utilizing the standardized curriculum approved by the Board.

#### Regulation .03 Authorization to Practice.

*COMAR 10.27.21.03*

A. An individual may be certified as:

  (1) A registered nurse forensic nurse examiner-adult (RN-FNE-A);

  (2) A registered nurse forensic nurse examiner-pediatric (RN-FNE-P); or

  (3) A registered nurse forensic nurse examiner-adult/pediatric (RN-FNE-AP).

B. An applicant applying for certification to practice as an RN-FNE-A, RN-FNE-P or RN-FNE-AP shall:

  (1) Either:

    (a) Hold a current license to practice as a registered nurse in Maryland; or

    (b) Have a multistate licensure privilege to practice registered nursing;

  (2) Have at least 18 months of continuous clinical experience as a registered nurse;

  (3) Complete a training program that includes a standardized curriculum approved by the Board and designed for the RN-FNE-A;

  (4) Complete in full the application for certification in the category selected; and

  (5) Pay all fees established by the Board in COMAR 10.27.01.02.

C. In addition to the requirements listed in §B of this regulation, an applicant applying for certification as an RN-FNE-P or RN-FNE-AP shall complete a training program that includes the following standardized curricula approved by the Board:

  (1) The standardized curriculum designed for the RN-FNE-A; and

  (2) The standardized curriculum designed for the RN-FNE-P.

D. A registered nurse who has been certified by the Board as a SAFE on or after December 13, 1999 may be certified to practice as an RN-FNE-A, RN-FNE-P, or RN-FNE-AP if the individual:

  (1) Submits a form required by the Board attesting that the individual has:

    (a) Served in the role of SAFE for 200 hours in the previous 12 months;

    (b) Obtained a total of 8 education clock hours in forensic science or forensic nursing in the previous 12 months;

    (c) Completed three sexual assault evidentiary examinations in the previous 12 months with respect to:

      (i) Adults and individuals 13 years old or older if applying for RN-FNE-A;

      (ii) Children who are younger than 13 years old if applying for RN-FNE-P; or

      (iii) Each category, if applying for RN-FNE-AP, for a total of six examinations; and

  (2) Complies with all other requirements of this chapter.

E. The Board shall:

  (1) Maintain an up-to-date list of all RNs certified to practice as RN-FNEs in the State; and

  (2) Include on the RN's license an indication that the licensee is certified to practice as an RN-FNE, and a designation of the RN-FNE's area of specialization.

#### 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.

#### Regulation .05 Standards for Training Programs.

*COMAR 10.27.21.05*

A. The Board shall approve two RN-FNE standardized curricula as follows:

  (1) An RN-FNE-Adult curriculum for the examination of adults and individuals 13 years old or older; and

  (2) An RN-FNE-Pediatric curriculum for the examination of children who are younger than 13 years old.

B. New RN-FNE training programs shall:

  (1) Be approved by the Board before implementation of the FNE training program;

  (2) Ensure that the didactic and clinical experiences are the same as existing FNE programs;

  (3) Teach the Board-approved curriculum in forensic nurse practice and forensic evidentiary examinations; and

  (4) Submit the qualifications and curriculum vitae of each faculty member to the Board for review before implementation of the training program.

C. An application for a new FNE program shall be submitted to the Board at least 6 months before the date of the first class.

D. The successful completion of the RN-FNE-Adult training program shall be a prerequisite to admission to the RN-FNE-Pediatric training program.

E. The RN-FNE-Adult training program shall include a minimum of 80 clock hours that includes:

  (1) A minimum of 40 clock hours of theory; and

  (2) A minimum of 40 clock hours of clinical experience with adults and individuals 13 years old or older.

F. The RN-FNE-Pediatric training program shall include a minimum of 62 clock hours that includes:

  (1) A minimum of 30 clock hours of theory; and

  (2) A minimum of 32 clock hours of pediatric clinical experience.

G. All clinical requirements for an FNE training program shall be completed within a 12-month period.

H. Faculty Qualifications.

  (1) An RN-FNE educator who meets the requirements of this section or a physician whose credentials demonstrate experience in the skills required in forensic evidentiary examinations is qualified to teach both theory and clinical portions of the curriculum and may serve as clinical preceptor for the clinical practicum of the FNE training program.

  (2) An RN-FNE educator who teaches in an RN-FNE training program or is the clinical preceptor of the training program shall:

    (a) Be approved by the coordinator of the FNE program: and

      (i) Have 2 years of experience as an RN-FNE or as a SANE, if from another state;

      (ii) Have 1 year of FNE experience with ten forensic examinations performed; or

      (iii) Be deemed by the FNE program coordinator to have the necessary FNE experience and competencies;

    (b) Have experience teaching the adult learner;

    (c) Possess broad knowledge and experience in the multidisciplinary treatment approach to family or sexual interpersonal violence, including intervention techniques; and

    (d) Have either:

      (i) Qualified as a forensic nurse examiner expert witness in a criminal proceeding; or

      (ii) Obtained trial preparation experience with the State's attorney's office.

  (3) The clinical preceptor for the clinical practicum of the FNE training program shall document the clinical competency of the RN-FNE candidate at the completion of the clinical practicum.

I. All changes, additions, or deletions to the FNE training program shall be submitted to the Board for approval not later than 3 months before the date of the first class.

#### Regulation .06 Certification by Endorsement.

*COMAR 10.27.21.06*

A. Endorsement Applicant.

  (1) In addition to the requirement listed in Regulation .03 of this chapter and COMAR 10.27.01.09, an applicant from another state applying for certification to practice as a RN-FNE, RN-FNE-P, or RN-FNE-AP shall:

    (a) Meet all applicable requirements in §§B—C of this regulation;

    (b) Provide evidence of an active practice as a sexual assault nurse examiner which meets the requirements for renewal of certification as stated in Regulation .07 of this chapter;

    (c) Demonstrate competency of a three orifice evidentiary examination by simulation as verified by a Board approved RN-FNE educator;

    (d) Complete the endorsement process within 6 months from the date of initial application;

    (e) Complete in full the application for certification in the area of specialization; and

    (f) Pay all fees established by the Board in COMAR 10.27.01.02.

  (2) An applicant who does not meet the requirements for renewal under Regulation .07 of this chapter shall complete a Board approved refresher course which is 6.5 hours of didactic education including, but is not limited to:

    (a) Evidence based best practice for forensic evidentiary examination;

    (b) Evidence collection;

    (c) Local jurisdiction requirements; and

    (d) Maryland criminal law.

  (3) An applicant who fails to meet the criteria for endorsement shall meet the requirements in Regulation .03 of this chapter.

B. An applicant from another state applying for certification to practice as a RN-FNE shall submit evidence of prior training and certification by providing the Board with:

  (1) A current national SANE-A or SANE-P certification, or both, from IAFN; or

  (2) Proof of successful completion of a SANE-A or RN-FNE-A, adult curriculum which is:

    (a) Substantially equivalent to the Board’s approved RN-FNE-A curriculum; and

    (b) A minimum of 80 clock hours that includes:

      (i) A minimum of 40 clock hours of theory; and

      (ii) A minimum of 40 clock hours of clinical experience with adults and individuals 13 years of age or older.

C. An applicant from another state applying for certification to practice as a RN-FNE-P or RN-FNE-AP, shall submit proof of successful completion of the following two curricula:

  (1) A SANE-A curriculum as referenced in §A(1) of this regulation; and

  (2) A SANE-P or RN-FNE-P, pediatric curriculum that is:

    (a) Substantially equivalent to the Board-approved RN-FNE-P curriculum; and

    (b) A minimum of 62 clock hours of instruction that includes:

      (i) A minimum of 32 clock hours of theory; and

      (ii) A minimum of 30 clock hours of pediatric clinical experience with individuals who are younger than 13 years of age.

#### Regulation .07 Renewal of Certification.

*COMAR 10.27.21.07*

A. Certification to practice as a FNE expires at the same time as the RN license.

B. Beginning January 1, 2016, renewal requirements will change to reflect the 2-year biennial license renewal that was implemented during 2015.

C. An FNE who has an even-numbered birth year shall be required:

  (1) Beginning January 1, 2016, to complete the renewal requirements under §E of this regulation; and

  (2) Beginning January 1, 2018, to complete the renewal requirements under §F of this regulation.

D. Beginning January 1, 2017, an FNE who has an odd-numbered birth year shall be required to complete the renewal requirements under §F of this regulation.

E. Before the certification to practice as an RN-FNE expires, the individual may renew for an additional term, if the RN-FNE:

  (1) Is otherwise entitled to be certified;

  (2) Has practiced in the role of RN-FNE for a minimum of 400 hours in the previous 24 months in a facility recognized to perform sexual assault forensic evidentiary examinations;

  (3) Has completed the following evidentiary examinations:

    (a) If applying for renewal as an RN-FNE-A, three evidentiary examinations on adult patients 13 years of age or older by simulation;

    (b) If applying for renewal as an RN-FNE-P, three evidentiary examinations on children who are younger than 13 years old; or

    (c) If applying for renewal as an FNE-AP, three evidentiary examinations on children who are younger than 13 years old, and an additional three evidentiary examinations on adult patients 13 years of age or older by simulation, for a total of six evidentiary examinations performed; or

    (d) Completed the following requirements:

      (i) If applying for renewal as an RN-FNE-A, performed ten speculum examinations and observed three evidentiary examinations on adult patients 13 years of age or older;

      (ii) If applying for renewal as a RN-FNE-P, has observed three evidentiary examinations on children who are younger than 13 years old;

      (iii) If applying for renewal as an FNE-AP, has observed three evidentiary examinations on children who are younger than 13 years old, has observed an additional three evidentiary examinations on adult patients 13 years of age or older, and performed ten speculum examinations on adult patients 13 years of age or older, for a total of six evidentiary examinations observed and ten speculum examinations performed; and

      (iv) Have a minimum number of cases submitted to peer review annually in accordance with §G of this regulation;

  (4) Provides evidence of having obtained a minimum of 8 education clock hours per year in forensic science or forensic nursing;

  (5) Pays all appropriate renewal fees set forth by the Board in COMAR 10.27.01.02; and

  (6) Submits an application for renewal of the certification on the form the Board requires.

F. Before the certification to practice as an RN-FNE expires, the individual may renew for an additional term, if the RN-FNE:

  (1) Is otherwise entitled to be certified;

  (2) Has practiced in the role of RN-FNE for a minimum of 400 hours in the previous 24 months in a facility recognized to perform sexual assault forensic evidentiary examinations;

  (3) Has completed the following evidentiary examinations:

    (a) If applying for renewal as an RN-FNE-A, six evidentiary examinations on adult patients 13 years old or older by simulation;

    (b) If applying for renewal as an RN-FNE-P, six evidentiary examinations on children who are younger than 13 years old;

    (c) If applying for renewal as an FNE-AP, six evidentiary examinations on children who are younger than 13 years old, and an additional six evidentiary examinations on adult patients 13 years old or older by simulation, for a total of twelve evidentiary examinations performed; or

    (d) Completed the following requirements:

      (i) If applying for renewal as an RN-FNE-A, performed twenty speculum examinations and observed six evidentiary examinations on adult patients 13 years old or older;

      (ii) If applying for renewal as an RN-FNE-P, has observed six evidentiary examinations on children who are younger than 13 years old; or

      (iii) If applying for renewal as an FNE-AP, has observed six evidentiary examinations on children who are younger than 13 years old, has observed an additional six evidentiary examinations on adult patients 13 years old or older, and has performed ten speculum examinations on adult patients 13 years old or older, for a total of twelve evidentiary examinations observed and ten speculum examinations performed; and

      (iv) Have a minimum number of cases submitted to peer review annually in accordance with §G of this regulation;

  (4) Provides evidence of having obtained a minimum of 16 education clock hours per 24 months in forensic science or forensic nursing;

  (5) Pays all appropriate renewal fees set forth by the Board in COMAR 10.27.01.02; and

  (6) Submits an application for renewal of the certification on the form the Board requires.

G. Peer Review.

  (1) As a condition of renewal, the following number of cases shall be submitted annually to peer review:

    (a) Three cases for an RN-FNE-A;

    (b) Three cases for an RN-FNE-P; and

    (c) Three adult cases and three pediatric cases for a total of six cases for an RN-FNE-AP.

  (2) An examination done by simulation may be included in the cases for peer review.

H. If the individual does not meet the requirement of §§E(2) and F(2) of this regulation, the individual shall complete a Board-approved course before becoming eligible for renewal of the certification.

I. With respect to the requirement set forth in §§E(3) and F(3) of this regulation, an examination performed on a live model or by simulation may substitute for evidentiary examinations for the purpose of certificate renewal.

#### Regulation .08 Reinstatement of Certification.

*COMAR 10.27.21.08*

A. If the applicant does not meet the requirements in Regulation .07 of this chapter, the applicant may apply for re-instatement if the applicant:

  (1) Either:

    (a) Has a current, active RN license; or

    (b) Has a multistate licensure privilege to practice registered nursing;

  (2) Has not practiced as a RN-FNE for more than 36 months;

  (3) Has successfully completed a Board-approved refresher course that is 6.5 hours of didactic instruction for the RN-FNE which includes, but is not limited to:

    (a) Evidence based best practice for forensic evidentiary examination;

    (b) Evidence collection;

    (c) Local jurisdiction requirements; and

    (d) Maryland criminal law; and

  (4) Has demonstrated clinical competency of a three orifice evidentiary examination for:

    (a) An adult patient 13 years of age or older or by simulation for certification as an RN-FNE-A;

    (b) Children younger than 13 years of age for certification as an RN-FNE-P; or

    (c) An adult patient 13 years of age or older by simulation and by patient examination on children younger than 13 years of age or older for certification as an RN-FNE-AP.

B. An applicant for reinstatement of certification has 6 months from the date of initial application to complete the reinstatement process.

C. An applicant who fails to meet the criteria for reinstatement of the certification shall meet the requirements in Regulation .03 of this chapter.

#### Regulation .09 Unlawful Practice.

*COMAR 10.27.21.09*

A. Unless authorized to practice under this chapter, an individual may not use the words “forensic nurse examiner” or the acronyms “RN-FNE”, “RN-FNE-A”, “RN-FNE-P”, or “RN-FNE-AP”, or any other words, letters, or symbols with the intent to represent the individual as any category of RN-FNE.

B. An individual may not use any form of the designation RN-FNE unless authorized by the Board.

C. An individual may not offer to perform or perform the activities of a RN-FNE enumerated in Regulation .04A of this chapter unless certified under this chapter or otherwise permitted by law to engage in these activities.

D. A registered or licensed practical nurse may not perform any task or function listed under Regulation .04A of this chapter unless certified under this chapter.

E. An individual authorized under this chapter to practice as an RN-FNE is subject to the disciplinary prohibitions and sanctions set forth in Health Occupations Article, Title 8, Annotated Code of Maryland.