| 1 | Date and Time of start | 65 | 35 | Dates are recorded in all the notes. This percentage is combined representative of date and time documentation |
| 2 | Address labels | 21 | 79 | Few notes have written notes with no labels |
| 3 | Child protection register | 87 | 13 | Documentation was good in the written notes but information lost in reports |
| 4 | Indication/ source of referral | 100 | 0 | All reports and notes had clear mention of source and indication of referral. |
| 5 | Verbatim documentation | 89 | 11 | Few Hand written notes were difficult to interpret. |
| 6 | Who when, where about injuries | 85 | 15 | |
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| 7 | Consent for photography and photography documentation in report | 33 | 67 | Very few notes had mention about the photograph taken. |
| 8 | Time interval between examination and report prepared <48 hrs | 84 | 16 | Most of the reports were done with in 48 hrs. |
| 9 | Reporting of Consistency of injury with history | 88 | 12 | in few reports skewed messages were given rather than clear documentation about consistency |
| 10 | Opinion regarding case and further clear management plan | 85 | 15 | Few ambiguous opinion were marked as not recorded after discussion with consultant |
| 11 | Report Copied to all appropriate personals involved | 85 | 15 | |
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| 12 | Time of end of examination | 0 | 100 | Recorded in all reports |