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14th Annual Event 2024
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2024 Holiday Drive
When Faith Hurts
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Llyn Strong Jewelry Collection
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Donate Now
Home
About
Julie Valentine Story
Testimonials
Confidentiality Policy
Board of Directors
Staff
Careers
Services and Statistics Infographic
Newsletter
Hotline Chat
Rape Crisis and Adult Services
Rape Crisis
Family Planning Resources
Sexual Health After Trauma
Specific Populations and Topics
Newsletter
Resources and Materials
Adult Therapy and Survivor Support Groups
Supporters of Survivors
Self Care Exercises
Chaplaincy Program
Spiritual Care Services
CPE
Child Advocacy Center
Child Advocacy Services
multidisciplinary team resources
Child Therapy
Caregiver Group Services
Education and Resources
Community Education Programs
Caregiver and Community Partner Resources
Training Opportunities
Fundraising Events
Have A Heart Participating
16th Annual Run2Overcome 5k/10k
14th Annual Event 2024
JVC Event Photos
Get Involved
2024 Holiday Drive
When Faith Hurts
Volunteers
Donors
Wishlist
Llyn Strong Jewelry Collection
Newsroom
Contact
Donate Now
[JVC] Client Contact Sheet for Volunteers
*
Indicates required field
Victim Advocate Name
*
First
Last
Client Information
Name
*
First
Last
Nickname
*
First
Last
[object Object]
Date of Birth M/D/YY
*
Non-English Speaking
*
Race
*
Caucasian
African American
Latino/Hispanic
Native American/Alaskan
Asian/ Pacific Islander
Multiracial
Other
Non-Identified
Gender
*
Male
Female
Nonbinary
Other
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Interpreter Needed?
*
Yes
No
Maybe
Age
*
Phone Number
*
Cell Phone Number
*
Other Phone Number
*
Interpreter Language Needed?
*
If client is a minor, list contact person
*
Relationship to Client
*
Contact # for caregiver
*
Disabilities
*
Mentally/Emotionally Challenged
Physically/Medically Challenged
No Identifiable disability
Underserved
*
Older women (over 65)
LGBTQ
Immigrant
Women at Risk (prostitute/substance abuser)
Call Options
*
Do NOT call
Okay to call
Okay to leave message
Okay to mail a letter
Okay to email
Victim Advocacy Session
Date of Contact with Client M/D/YY
*
State of Incident
*
Time called client back or time arrived at ER
*
Assault Information
*
Rape
Attempted Rape
Stalking
Fondling
Sexual Harassment
Alcohol/Drugs Involved
Current Domestic Violence
Past Domestic Violence
Weapon Involved (hands not considered a weapon)
Child Sexual Abuse (0-17)
Adult Survivor of Child Sexual Abuse
Unknown
Other
*
Status
*
Attended
Attempted
Left Message
Other
Time Contacted by Answering ServiceUntitled
*
Time call ended or time finished ER accompaniment
*
Provided Services
*
Hotline Call
ER Accompaniment
ER Notification
Information and Referral
Shelter
Narrative of Hotline Call and/or ER Accompaniment
*
ER Accompaniment
Date Arrived at ER M/D/YY
*
Date Left ER M/D/YY
*
Hospital
*
Greenville Memorial
Greer Memorial
Hillcrest Hospital
North Greenville
St Francis Downtown
St Francis Eastside
St Francis Simpsonville
Village of Pelham
Rape Kit Performed?
*
Yes
Time Arrived at ER
*
Time Left ER
*
Name of Nurse
*
Anonymous Kit?
*
Yes
If Anonymous, Medical Record Number (MRN)
*
Clothing Items Provided
*
Underwear Includes panties, boxers, and bras
Shirts
Pants
Shoes
Socks
Other Services Provided
*
Taxi
Shelter
Was SANE nurse available?
*
YES
Underwear Size
*
Shoe Size
*
Shirt Size
*
Pants size
*
Bra Size
*
Items needed at ER
*
MRN Number
*
Sexual Assault Kit Tracking System Password
*
Sexual Assault Kit Tracking System Username
*
Agencies Involved
Agencies Involved
*
Greenville County Sheriff's Office
Greenville City PD
Greer PD
Mauldin PD
Travelers Rest PD
Simpsonville PD
Laurens County Sheriff's Office
Anderson County Sheriff's Office
Pickens County Sheriff's Office
Other
*
Name of Officer
*
DSS
*
Case Number
*
Name of DSS Case Worker
*
Submit
Home
About
Julie Valentine Story
Testimonials
Confidentiality Policy
Board of Directors
Staff
Careers
Services and Statistics Infographic
Newsletter
Hotline Chat
Rape Crisis and Adult Services
Rape Crisis
Family Planning Resources
Sexual Health After Trauma
Specific Populations and Topics
Newsletter
Resources and Materials
Adult Therapy and Survivor Support Groups
Supporters of Survivors
Self Care Exercises
Chaplaincy Program
Spiritual Care Services
CPE
Child Advocacy Center
Child Advocacy Services
multidisciplinary team resources
Child Therapy
Caregiver Group Services
Education and Resources
Community Education Programs
Caregiver and Community Partner Resources
Training Opportunities
Fundraising Events
Have A Heart Participating
16th Annual Run2Overcome 5k/10k
14th Annual Event 2024
JVC Event Photos
Get Involved
2024 Holiday Drive
When Faith Hurts
Volunteers
Donors
Wishlist
Llyn Strong Jewelry Collection
Newsroom
Contact
Donate Now