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Get Self Report Letter Working Form

Rovider Investigation Report Form (DADS Form 3613) Effective: June 1, 2006 Purpose and Background The purpose of this letter is to provide guidance to HCSSAs in making self-reports of abuse, neglect, and/or exploitation (A/N/E) of agency patients/clients by agency employees. HCSSAs are required to selfreport allegations of A/N/E to both the Department of Family and Protective Services (DFPS) and the Department of Aging and Disability Services (DADS) under Texas Health and Safety Code 142.01.

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