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DOCUMENTATION: Photographic Documentation

When properly taken, good photographs provide irrefutable evidence. They may add credibility to the patient's statements and reduce the likelihood of medical testimony because the evidence is clear. However, photographs never substitute for accurate, detailed written descriptions. They are pictorial depictions of such documentation.

Consent and Cooperation
line spacer In New York State, parent or guardian permission for taking photographs should be sought but is not necessary once suspected child abuse has been reported to the State Central Register. Document the consent or refusal in the medical record. According to New York State Social Services Law ~ Section 416, the photographs should be sent to Child Protective Services at the time the report is sent, or as soon after as possible.

Photographs are part of the medical chart. As such, they are legal documents subject to the same guidelines that govern the storage and release of other medical records. Medical and other facilities involved in child abuse evaluations should have a protocol in place for the release of photographs. Proper request, either by subpoena or other means, and signatures of receipt should be the minimal requirements for releasing photographs to an investigative agency. Note that a chain of custody may be necessary for photographs, particularly if the photographer is not available for testimony to attest to the true and accurate representation of the photos

Inform the child/adolescent of the need for pictures and engage him/her in the process. In some cases, photographing the physical or sexual abuse findings may embarrass the child/adolescent. Be sensitive to this possibility and be able to explain why such documentation is needed. In many cases, young children will cooperate if they are allowed to help with the process. Very young children may not hold still for photographs. In order to obtain accurate photographs, it may be necessary to have an assistant or two distract the child. In some cases the child or adolescent may refuse to have photographs taken. Do not take photographs when the older child or mature minor does not consent.

Photographic Equipment
line line The equipment can include a 35 mm camera with a close-up system that produces prints or slides, photocolposcopy using 35 mm or digital technology, and video recording. Digital photography is fast replacing the use of print film in large evaluation centers. The equipment includes digital adaptation of standard colposcopes and the more advanced digital camera mounted colposcope with computer software for documentation and storage of findings and text. Digital technology produces images that can be stored easily and printed when needed. However, for legal reasons, take care to avoid changing the image in any way. In general, Polaroid photography is not recommended because of the inability to get good quality close-up pictures.

In addition, consider having a tripod, light meter, and color wheel. The color wheel is often necessary to document true color when bruises or erythema is present.

Taking Good Photographs
line spacer The principles of photography in child abuse include proper planning, good equipment and lighting, and planned composition:

  • Utilize a system to keep track of the patient's name and date of the photographs, such as a name card with date and name written in black marker.

  • Use one roll of film per patient. Take a picture of the child/adolescent's face with the name card to identify him/her.

  • Take full body photographs for identification purposes.

  • When photographing the person's back, have the child/adolescent turn his/her face toward the camera for identification purposes.

  • Take photographs head on so that the surface that is to be photographed is parallel to the camera and at the same level.

  • Compose the picture the way you normally look at the area.

  • Use an uncluttered, neutral-colored background. Skin is best photographed against a blue background.

  • Lighting is crucial to accurate color reproduction. In the absence of proper lighting, it is very important to document in writing in the medical chart the color and description of the lesion.

  • Use a color wheel for color comparisons if necessary. Take the photograph with the color wheel in the photo.

  • Duplicated slides will likely have distorted color. Take two or three shots of the same view instead.

  • Document a finding with several shots taken from different distances and angles. Take some photographs of a lesion that include landmarks such as an elbow or a knee so that the lesion is seen in its proper location.

  • Use the rule of three. Take at least two shots of three orientations: full body, medium range of the finding, and close up.

  • Document the size of the injury by using an inch scale. Be sure that there is at least one other close-up of the injury without the scale to demonstrate the scale was not covering evidence.

  • Document pattern or circumferential injuries, such as burns and bite marks, using photographs showing antero-posterior and lateral views.

  • Use close-ups to document pattern injuries and marks of restraint or bondage so that these injuries might later be compared with the rope or object that made the marks.

  • Take close-up photographs of hands and fingernails to show damage to the nails; missing nails; or traces of blood, skin, or hair.

  • Photograph transfer evidence that may be present on the body or clothing, such as dirt, gravel, or vegetation.

  • Ultraviolet light may be helpful for photographing bite wounds months later even when the overlying skin appears totally normal.

  • It may be useful to take serial photos of injuries over a period of time to show progression of healing.

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Documentation: Overview  Documentation: Documenting the History  Documentation: Documenting the Findings  Documentation: Documenting the Diagnosis  Documentation: Documenting Other Information  Documentation: Photographic Documentation  Documentation: Coding for Billing  Documentation: Additional Resources 

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On this page:
Consent and Cooperation
Photographic Equipment
Taking Good Photographs