Thank you for your interest in the Upper Valley Human Rights Clinic. We provide pro bono forensic evaluations for clients seeking asylum. Please read on below for more details regarding our clinic's policies and procedures. You can also download a PDF copy of our letter to attorneys and legal aid clinics HERE.
- Please complete our case referral form at: https://form.jotform.com/211980457454057
- Please send your client’s statement/sworn declaration and any other supporting documents (including medical records) to Asylum Coordinator email@example.com
- After we receive the case referral form and client’s sworn declaration, we will use the information to determine if we are able to perform the evaluation, and if so, prepare accordingly for it.
- If we agree to take on the client’s evaluation, we will work with you to choose a date and time to conduct the evaluation.
- Before the evaluation, there are some paperwork and confidentiality agreements that will need to be signed. We can share these with you beforehand so you and your client can review them.
- The evaluation will then be conducted by an evaluation team consisting of physician evaluators (including attending, fellow, and resident physicians), an assisting medical student evaluator, and any medical interpreters (as needed), for a total of 2-3 hours or as long as needed. We will make every effort to provide a medical interpreter for the evaluation. However, please be prepared to provide a qualified, non-family member interpreter if needed.
- Following the evaluation, we will prepare and share with you a draft affidavit within 2-3 weeks. You will have an opportunity to make comments and share any concerns, inclusions or exclusions that you would like us to make in the document before it is signed and notarized. The asylum coordinator will contact you by email with any questions that our physician evaluators have as they draft the affidavit.
- A scanned copy of the final, signed and notarized affidavit will be shared with you to submit.
To maintain client privacy and confidentiality, we assign a pseudonym for all discussions about the client. Any client identifying information will only be shared with the Good Neighbor Health Clinic (GNHC) and Dartmouth Hitchcock Medical Center at the time of evaluation, where the client’s identity will be protected under HIPAA.
Please review the information below pertaining to the evaluation type for your client. The specific type of evaluation will be guided by shared decision making between the clinic staff and the client’s legal counsel, and a final decision will be made based on clinic staff availability and client indications for a medical evaluation with psychiatric screening or a formal psychiatric evaluation.
Our medical evaluations include a full history, physical exam, and basic psychological screening evaluation by a family physician or internist. The evaluation team will consist of one or more primary attending physicians, assisting residents and medical student evaluators, and any medical interpreters (as needed).
An intake form and confidentiality agreement will need to be completed prior to the evaluation since we are using clinic space at the Good Neighbor Health Clinic in White River Junction, VT. These will be sent to you by the asylum coordinator and are also available upon request. We take the utmost care not to share any client information and protect their privacy and confidentiality. These forms can also be completed in person on the day of the evaluation depending on client preference.
Parking and Visit Information
Medical evaluations will take place at The Good Neighbor Health Clinic, located at 70 N Main Street, White River Junction, VT 05001. We are unable to offer virtual medical evaluations at this time. Please contact us if you believe your client’s situation warrants a virtual evaluation. Please have the client park in the lot across from St. Anthony's church, which is a 1-minute walk from the Good Neighbor Health Clinic. The address for parking is 41 Church St, White River Junction, VT 05001.
When the client arrives, they can ring the doorbell to be let inside.
We advise the client to wear comfortable clothing that is conducive to a physical exam. As some evaluations can occur during meal times, please have the client prepare accordingly or bring food with them if needed.
To adhere to the clinic’s policies on visitors and protect the client’s confidentiality, family members and other support persons are asked to remain outside the building for the duration of the evaluation. If the client would like to have a companion accompany them inside the building for support, please inform us in advance.
Our psychological evaluations include a full history and evaluation by a psychiatrist or psychologist. Depending on the age of the client, the evaluation team will consist of a primary evaluating physician (usually an adult psychiatry resident or child & adolescent psychiatry fellow), a supervising attending physician, assisting medical student evaluators, and any medical interpreters (as needed).
Intake paperwork will need to be completed prior to the evaluation since we are using clinic space at the Dartmouth-Hitchcock Medical Center in Lebanon, NH. These will be sent to you by the asylum coordinator and will need to be returned 1 week before the evaluation date. We take the utmost care not to share any client information and protect their privacy and confidentiality.
Parking and Visit Information
Psychological evaluations will take place at Dartmouth Hitchcock Medical Center, Lebanon campus. The address is, 1 Medical Center Drive, Lebanon NH 03766. Once you arrive at Dartmouth Hitchcock Medical Center, please make your way to 5D and wait in the waiting room. Please arrive at least 30 minutes early, allowing for the provider to organize for translation services and an evaluation room. We are able to offer both virtual and in person psychological evaluations depending on your client’s needs.
To adhere to the hospital’s policies on visitors and protect the client’s confidentiality, family members and other support persons are asked to wait in the waiting room outside the 5D reception area.