Nearly all states and provinces have laws mandating licensed healthcare professionals to report to law enforcement suspicions and allegations of the abuse of children, older adults, and disabled persons and all incidents of violence by a deadly weapon. However, a few states in the United States additionally mandate providers to report all injuries resultant from reported or suspected domestic/intimate partner violence. This can present a challenge to forensic nurses seeking to protect patient confidentiality and autonomy. This challenge becomes further compounded when a patient desiring to remain anonymous reports sexual assault by their partner, accompanied by bodily injury. This case report explores one such scenario that occurred in a rural Colorado Emergency Department, the issues this presents to forensic nurses, and possible responses.