अनुसूची–१६ (दफा २२ को उपदफा (१) सँग सम्बन्धित) घाउ जाँच केश फारामको ढाँचा

अनुसूची–१६ (दफा २२ को उपदफा (१) सँग सम्बन्धित) घाउ जाँच केश फारामको ढाँचा

(दफा २२ को उपदफा (१) सँग सम्बन्धित)
घाउ जाँच केश फारामको ढाँचा



  1. Case Registration No.:
  2. Name of the Office referred for injury examination (with letter ref. No. and Date) :
  3. Name, Age, Date of birth and Sex of the injured person:
  4. Address:
  5. Name of the accompanying Police Personnel:
  6. Name of the Hospital/Health centre:
  7. Date, time and place of examination:
  8. Identification mark of the examinee :
  9. Consent for examination taken from :

Injured person                       Family member or others

10. Brief history about the incident (how and when the injuries were produced?):

11. Medical history of the examinee :

  1. General Physique and vitals :

Height:       Weight:              Pulse:         B.P.:                    B.P:

Temperature:                                             Respiratory Rate:

Temperature:                         Respiratory Rate:

Degree of Consciousness:

13. Injuries (Name, Size, Site, Color, Surrounding area, Signs of treatment, Bleeding Marks, Sign of Healings, any Imprints and content etc.) :

A. Type of injury

a. Simple:

b. Angabhanga (Grievous) :

c. Severe:

d. Other remarks:

B. Type of weapon/object used:

(i) Blunt force              (ii) Sharpe force
(iii) Pointed objects     (iv)Projectile                     (v) Heat
(vi) Chemical                   (vii) Others  (Specify)

C. Condition of the patient at the time of examination :

D. Severity (Explain the severity  in terms  of  existing condition and possible  complication) :

E. Investigation and reports (for example X-ray, USG, Blood, Urine etc) :

F. Treatment provided (briefly) :

G. Referral (Where and Why?):

H. Follow up (if necessary ) :

I. Re- Examination (Whether case needs information about grade of disability ) :

Opinion: (Condition of examinee, severity of the injury, age of the injury and possible causative objects should be considered to frame opinion)

Name of the Examiner:              Signature:

Qualification:-                            MC ⁄ NHPC Reg. No. :

Office/Hospital/Health Centre: Date:

Seal of the Hospital/Health Centre:


  • घाउ जाँच कार्यसम्भव भएसम्म Forensic विषयको विशेषज्ञले र त्यस्तो विशेषज्ञ नभएमा तालिम प्राप्त चिकित्साकर्मीले गर्नु पर्नेछ ।
  •  घाउ जाँच गर्ने विशेषज्ञ वा चिकित्साकर्मीले नै प्रतिवेदन तयार गर्नु पर्नेछ ।
  • सम्भव भएसम्म कम्युटर टाइप गरी प्रतिवेदन तयार गर्नु पर्नेछ, सो नभएमा स्पष्ट बुझिने गरी उल्लेख गर्नु पर्नेछ । साथै परीक्षण प्रतिवेदनको सक्कल प्रति नै संलग्न गर्नु पर्नेछ ।
  •  निर्धारित स्थानमा विवरण उल्लेख गर्न नपुग भएमा छुट्टै पानामा समेत विवरण उल्लेख गर्नु पर्नेछ ।