Get Act 13 Abuse Reporting Form

Filling out the Act 13 Abuse Reporting Form accurately is crucial for reporting suspected abuse of individuals receiving care. This guide provides a clear, step-by-step approach to complete the form online, ensuring that all necessary information is captured effectively.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date and time of the report at the designated field labeled 'Date of report/time'. This dates the report accurately for record-keeping.
3. Fill in the 'Name of victim' field with the last name, first name, and middle initial of the individual suspected of being abused.
4. Provide the victim's current address, including details for 'Address', 'City', 'State', and 'Phone'.
5. Enter the date of birth and select the sex of the victim from the options available on the form.
6. Identify the type of alleged abuse by placing an 'x' in the appropriate box that best describes the situation.
7. Document the 'Date and time of incident' when the suspected abuse took place.
8. Provide details regarding the facility where the victim is cared for, including 'Facility name', 'Address', 'City', 'State', 'Phone', and 'Facility type'.
9. Complete the 'Licensing agency' and 'License number' fields related to the facility.
10. Record the actual dates and times of oral reports made to the Area Agency on Aging, local law enforcement, and the Pennsylvania Department of Aging, as required.
11. Fill out contact details for the facility's guardian and next of kin if applicable, including their name, address, and relationship to the victim.
12. Provide information regarding the alleged perpetrator, including their name, relationship to the victim, address, age, and sex.
13. Offer a detailed description of the suspected abuse incident in the designated section.
14. Document the actions taken by the facility in response to the alleged abuse, including any notifications made to authorities.
15. Complete the 'Name and title of reporter' section with the details of the person reporting the incident and ensure to provide a signature.
16. Finally, review all provided information for accuracy, then save, download, or print the form as needed for submission.

Act now to ensure the safety of individuals in care by completing the Act 13 Abuse Reporting Form online.