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Get MI DHS-3200 2008

STRUCTIONS: REPORTING PERSON: Complete items 1-21 (22-30 should be completed by medical personnel, 1. Date if applicable). Send PART 1 to local County DHS where the child is found. Retain PART 2 for your records. See additional instructions on back. 2. List of child(ren) suspected of being abused or neglected (list additional children on back of Part 1) NAME BIRTH DATE SOCIAL SECURITY # SEX RACE 3. Mother’s name 4. Father’s name 5. Child(ren)’s address (No. & Street) 6. City 7. Coun.

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