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Figure 2. Excerpts from the Domestic Violence Survivor Assessment Form: Issues about the Relationship—Medical Care for Domestic Violence Injuries and Stress
|Ignores stress and injuries when with others. Copes alone.
Committed to continuing.
|For safety, delays care and counseling/therapy. Seeks initial treatment; lies regarding abuse.
Considers change: abuse and options
|Uses medical care and counseling/therapy. May have ongoing health and emotional problems from domestic violence.|
Establishes a new life—apart or together.
Source: Jacqueline Dienemann, Visiting Professor, University of North Carolina at Charlotte, Department of Adult Health Nursing, 9201 University City Boulevard, Charlotte, NC 28223; E-mail: email@example.com or firstname.lastname@example.org. Used with permission.
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