Get Wv Adult Protective Services Mandatory Reporting Form 2017-2026

This guide provides detailed instructions on how to effectively fill out the West Virginia Adult Protective Services Mandatory Reporting Form online. It is crucial for individuals to accurately report suspected abuse, neglect, financial exploitation, or an immediate risk of serious injury to ensure the safety of vulnerable adults.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the mandatory reporting form and open it in your preferred online form editor.
2. Begin by entering the referral number at the top of the form, which is necessary for tracking the report.
3. In the 'Alleged Victim Information' section, input the date the referral was made to Centralized Intake, along with the name, age or date of birth, address, phone number, and current location of the alleged victim.
4. Complete the information pertaining to the facility name and type, if applicable, as well as a description of the alleged victim's physical, cognitive, and emotional functioning.
5. Identify the substitute decision maker by providing their type, name, address, and telephone number, if there is one.
6. Proceed to the 'Alleged Perpetrator Information' section, and fill in the name, age or date of birth, home mailing address, current location, title or relationship to the victim, and phone number of the alleged perpetrator.
7. In the 'Allegations' section, provide the date and time of the incident, the date the report is being completed, and where the incident took place.
8. Describe the incident in detail, including any injuries sustained, actions taken to prevent further abuse or neglect, whether treatment outside the facility was required, and the name of the treatment provider.
9. Indicate why the adult is unable to protect themselves, how long the abuse or neglect has been occurring, and if there are any witnesses or others aware of the incident.
10. Once all sections are filled out, review the form for completeness and accuracy. Attach additional pages if needed and mark the appropriate box.
11. Finish by saving, downloading, or printing the completed form. Ensure you file the original form with the local Adult Protective Services Unit and distribute copies, as required.

Take action now by filling out the WV Adult Protective Services Mandatory Reporting Form online to report any suspected abuse or neglect.