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State of Hawaii DEPARTMENT OF HUMAN SERVICES Adult Protective Services ALLEGED VICTIM S REPORT FORM FOR ADULT ABUSE AND NEGLECT Chapter 346 Part X HRS Mail or Fax to APS Date of Incident Name s SexBirthdate Street Address Mailing Address ALLEGED PERPETRATOR S Identify facility if applicable Relation to victim DESCRIBE NATURE AND EXTENT OF INJURY OR HARM AND WHY REPORTER HAS REASON TO BELIEVE THE INCIDENT IS ABUSE NEGLECT OR EXPLOITATION ACTION TA.

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How to fill out the Edr Maps For Hawaii Form online

Filling out the Edr Maps For Hawaii Form online can seem daunting, but with clear guidance, you can complete it efficiently. This guide offers step-by-step instructions to help you navigate through each section of the form confidently.

Follow the steps to successfully complete the form online.

  1. Click 'Get Form' button to obtain the form and open it in the editor.
  2. Begin by entering the date of the incident in the designated field. Be precise with the date to ensure accurate reporting.
  3. Provide the name(s) of the alleged victim(s) in the corresponding field, followed by their sex and birthdate.
  4. Input the street address of the alleged victim(s) in the appropriate area, ensuring that the details are complete.
  5. Complete the mailing address section for the victim(s) if it differs from the street address.
  6. Identify the alleged perpetrator(s) and, if applicable, mention the facility involved. Indicate their relation to the victim.
  7. Fill in the name(s) of the alleged perpetrator(s) along with their sex and birthdate.
  8. Document the street address and mailing address of the alleged perpetrator(s) as applicable.
  9. In the section describing the nature and extent of injury or harm, provide thorough details on why you believe the incident constitutes abuse, neglect, or exploitation.
  10. Outline the actions you have taken as the reporter to assist the victim. Be specific in your description.
  11. Indicate whether you will continue to provide services to the victim by selecting Yes or No.
  12. If anonymity is requested, make your choice by selecting Yes or No.
  13. Fill in your name as the reporter, along with your telephone number and address. Include your facility name if applicable.
  14. Finally, check the form for any errors, save your changes, and proceed to download, print, or share the completed form as needed.

Take the next step in ensuring safety by completing your form online today.

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