Get Grpg 90-850 Appendix B Form 04-184 - Hhsa Program Guides - Hhsa-pg Sdcounty Ca

Filling out the GRPG 90-850 Appendix B Form 04-184 requires careful attention to detail to ensure accurate reporting. This guide provides clear, easy-to-follow instructions to help you complete the form online effectively.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name, title, and phone number in the 'Name/Title' section at the top of the form. This identifies you as the reporting party.
3. Provide information about the victim in section 2. Fill in the name, sex, birthdate, ethnicity, address, and phone number. It is important to also include the present location and the child's school or day care provider's name.
4. If there are any siblings of the victim, list their names, sex, birthdates, and ethnicity in the siblings section. Ensure that you complete all fields accurately.
5. In the parents/stepparents and others in the home section, provide the necessary details such as names, sex, relationship to the victim, address, and phone number for all individuals residing with the victim.
6. Fill out the alleged perpetrator section by including essential details like name, sex, address, relationship to the victim, birthdate, phone number, ethnicity, and language spoken.
7. Document the incident information. Specify the date and time of the incident, type of abuse (physical, mental/emotional, sexual assault, neglect, or other), and location of the abuse.
8. Provide a detailed narrative in sections 7, 8, and 9, describing the nature and extent of the abuse, the child's account of what happened, and any relevant history of abuse.
9. Review all sections for completeness and accuracy. If any information is unknown, indicate so appropriately.
10. Once all fields are filled out, you can save changes, download the form, and print or share it as needed.

Complete the GRPG 90-850 Appendix B Form 04-184 online today to ensure timely reporting.