South Carolina Attorney General's Office
South Carolina Crime Victim Services Division
Department of Crime Victim Compensation (DCVC)

Forensic Interview Release Form

In the matter of:


City / State / Zip (Required)

In accordance with South Carolina Victims and Witnesses Bill of Rights, signed into law on June 22, 1984, I hereby voluntarily consent and authorize the South Carolina Department of Crime Victim Compensation and its authorized agents to receive my interview records and to pay directly such expenses allowed by law to the Children's Advocacy Center for the forensic interview conducted for evidentiary purposes as prescribed by South Carolina Department of Crime Victim Compensation.

Signature of Patient/Guardian
Clear

Date: 08/02/2025
Please check.

The Children's Advocacy Center must attach a copy of the Forensic Interview Billing Claim Form and a law enforcement incident/supplemental report to this Forensic Interview Release Form for payment and forward to:

Department of Crime Victim Compensation (DCVC)

Edgar A Brown Building. 1205 Pendleton Street. Room 401 • Columbia, SC 29201
Telephone 803-734-1900 • Facsimile 803-734-2261

*DCVC will not cover the cost of the interview if such is not requested by a law enforcement officer.
*If a child is in the legal custody of another government agency, the cost of the exam will not be covered by DCVC.