Follow the steps to fill out the WV Adult Protective Services Mandatory Reporting Form online.

1. Select the ‘Get Form’ button to access the WV Adult Protective Services Mandatory Reporting Form and open it in your preferred online editor.
2. Begin by completing the referral number section, which is vital for tracking your report.
3. Record the date the referral was made to Centralized Intake, ensuring accuracy to maintain a proper timeline.
4. Provide comprehensive information about the alleged victim, including their name, age, address, phone number, current location, and any relevant facility details.
5. Describe the physical, cognitive, or emotional functioning of the alleged victim, as this will help assess their situation.
6. Include details of the substitute decision maker if applicable, providing their type, name, address, and telephone number.
7. Next, fill out the section for the alleged perpetrator, detailing their name, age, address, current location, and relationship to the victim.
8. Enter information regarding the allegations, including the date and time of the incident, where it occurred, and a detailed description of the incident or injuries sustained.
9. Indicate what actions have been taken to prevent further abuse or neglect, and specify if any treatment outside of a facility was required.
10. Answer why the adult is unable to protect themselves and provide the duration of the abuse or neglect.
11. List any individuals who are aware of the incident and include contact information for any witnesses.
12. Check the box if additional pages are needed to complete the report, and ensure these are marked correctly.
13. Finally, save your changes, then download, print, or share the completed form as necessary to the required parties.

Begin filling out the WV Adult Protective Services Mandatory Reporting Form online today to ensure the safety and well-being of those at risk.