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since they can be used as evidence of assault, particularly in legal proceedings. For example, medical records can be subpoenaed into court should another incident occur or if the patient decides to divorce and/or seek child custody or support. Victims of domestic violence should also be afforded appropriate evidence collection that follows recommendations set forth in the New York State Department of Health's Sexual Assault protocols.

Health care providers should not refrain from accurate and thorough medical record documentation out of concern that the patient might lose insurance coverage because she is a victim of domestic violence. In New York State, Chapter 174 of the Laws of 1996 prohibits insurance companies and health maintenance organizations from discriminating against domestic violence victims. Specifically, Chapter 174 outlaws designating domestic violence as a preexisting condition  and denying or canceling an insurance policy or requiring a higher premium or payment when the insured is/has been a domestic violence victim.

k.Strategies should be developed that ensure confidentiality in cases in which a provider/facility is treating both the abuser and the victim.

In cases where a health care provider or facility is treating both the victim and the abuser, ensuring that confidentiality procedures are strictly followed becomes even more critical. To this end, it is crucial that the victim and abuser be seen separately. Victim information should be kept strictly confidential and should not be disclosed to the patient who is the abuser without the express written consent of the victim.

l.Managed Care Organizations should ensure that their plans provide for coverage/reimbursement of emergency department visits by victims of domestic violence who may seek emergency care or shelter from an impending domestic violence assault.

While primary care settings are important for early identification and referral of domestic violence victims, they are generally not accessible 24 hours a day or on short or no notice. As a result, victims of domestic violence may seek refuge from an impending assault by accessing emergency department services. Many times, emergency departments may be best equipped to deal with victims in immediate crisis. Hospital emergency departments may have an established working relationship with local police and/or district attorney's office should the patient decide to pursue a criminal justice response to her victimization, and they are the prime providers of evidence collection in most

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