Get Vulnerable Adult Protective Services (vaps) Referral Form - Altru

Filling out the VULNERABLE ADULT PROTECTIVE SERVICES (VAPS) referral form is an essential step in ensuring that vulnerable individuals receive the protection and support they need. This guide provides clear and detailed instructions on how to navigate the form online, ensuring that all necessary information is accurately captured.

Follow the steps to complete the referral form effectively.

1. Press the ‘Get Form’ button to access the referral form and open it in your browser.
2. Begin by entering the vulnerable adult's name in the format of last name, first name, and middle initial.
3. Indicate the person's ethnic background by selecting the appropriate option.
4. Provide the complete address of the vulnerable adult, including the street address.
5. Fill in the city where the vulnerable adult resides.
6. Select the appropriate state from the dropdown list.
7. Enter the ZIP code for the vulnerable adult's address.
8. Provide the approximate age of the vulnerable adult.
9. List the contact telephone number of the vulnerable adult.
10. Record the source of your referral, such as 'friend,' 'family,' or 'concerned citizen.'
11. If applicable, provide the name of the agency involved in the referral.
12. Enter the agency's address, including street, city, state, and ZIP code.
13. Specify the relationship of the referrer to the vulnerable adult.
14. Provide the caregiver's name, if there is one.
15. Supply the caregiver's address and contact details.
16. Detail the nature and extent of the suspected neglect or exploitation, providing specific information that answers who, what, where, when, why, and how often.
17. Affix your signature as the reporting individual.
18. Select the priority level of the referral: 'Emergency,' 'Imminent Danger,' or assign a 'Priority #.'
19. Leave space for the signature of the worker who will handle the case.
20. Categorize the referral appropriately, selecting from options including physical abuse, sexual abuse/exploitation, emotional abuse, and neglect.
21. Note any special instructions that may be useful for follow-up contact or precautionary measures.
22. Record the name of the person who is documenting the case.
23. Indicate the source of your report, e.g., family, agency, or others.
24. Complete the date and time when the report is received in the agency.
25. Specify the method by which the report was received.
26. For agency use, record case disposition and case number.
27. Once all fields are completed, save your changes, then download, print, or share the filled form as needed.

Begin completing your VAPS referral form online today to help make a difference.