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The Urban Institute, with funding from the National Institute of Justice, is examining the role of the sexual assault medical forensic exam (SAMFE) in investigative and prosecutorial outcomes in two sites. As part of this project, Urban researchers conducted in-depth interviews with over 40 stakeholders to learn about law enforcement, prosecutor, sexual assault nurse examiner, service provider, and victim advocate perspectives on the utility of the SAMFE in case processing. Drawing from the findings from these interviews, we will discuss how different stakeholders facilitate and use forensic evidence in case processing, the impact of evidence in case outcomes, the challenges of collecting, storing, and utilizing forensic evidence throughout a sexual assault case, and the collaboration and coordination among stakeholders. Findings will inform the dearth of knowledge about the extent to which medical forensic exams lead to case outcomes such as arrest, charges, and conviction.