A sample police statement

Constable A Cop c/o MDA National
Somewhere City Police Dept advice@mdanational.com.au
Ph 1800 011 255
Fx 1300 011 235

 

Re:   Statement by Dr Alex Smith
        Patient Jean Doe (1 Dec 2000)

 

This statement made by me is true to the best of my knowledge and belief, accurately sets out the evidence that I would be prepared, if necessary, to give in court as a witness. I make this statement knowing that if it is tendered in evidence, I will be liable to prosecution if I have wilfully stated in it anything that I know to be false, or do not believe to be true.

1. On 1 January 2019 I was contacted by Constable A Cop from Somewhere City Police Department and requested to provide a statement in relation to the care of Jean Doe (Patient). Constable Cop provided a copy of the Patient’s consent to disclose confidential information to the court.
2. In preparing this statement, I have referred to the medical records of the Patient held at All Care GPs, Somewhere City (Practice).
3. I have a good recollection of the events discussed in this statement and have refreshed my recollection by referring to the medical records.

Professional Qualifications and Employment:

4. I have been a qualified registered medical practitioner for 10 years and a specialist GP for two years.
5. My qualifications include:
1. MBBS 2009 Somewhere City, Australia
2. Fellowship of the Royal Australian College of General Practitioners 2017

Chronology:

7. On Saturday 1 January 2019 I was working at the Practice in my role as a GP. I first became involved in the care of the Patient at 1000 hrs when I examined a person not previously known to me (although had attended the Practice previously), who identified themselves as the Patient.
8. The Patient presented for an alleged assault, which the Patient stated had occurred three days prior (28 December 2018).
9. The Patient described that they had been punched in the face (Mechanism of Injury).
10. Following review of the history, examination and investigation of the Patient, I noted the following injuries (the Injuries):
    1. A deformed nose (fractured nasal bone deviated to the right). The Patient was referred to an ENT surgeon for management.
    2. A laceration of the right nostril (nare) 4mm long. The wound was stitched under local anaesthetic by me and the patient was discharged on topical antibiotics with sutures to be removed by the ENT surgeon in one week.

Opinion:

11. My opinion is that the Injuries were consistent with the Mechanism of Injury.
12. Based on my review of the records, the patient was seen 1 June 2019 by another colleague at the practice and the Injuries had resolved. I am unaware if there are ongoing mental health concerns.
    1. The injuries did not likely pose a threat to life. Untreated, the nasal fracture and nasal laceration would have likely led to permanent facial deformity and scarring.
    2. The laceration penetrated all levels of the skin.
    3. The injuries would likely have interfered with bodily comfort.

 

Dr Alex Smith 
Signed at Somewhere City on this day, Wednesday, 6 November 2019

See also the article Requests and Subpoenas to Give Evidence in Court, Your day in court and A doctor's guide to police statements for more information.