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Get IA 470-2441 2002-2024

Artment of Human Services following an oral report of suspected dependent adult abuse. See page 2 for instructions. There are three criteria for a dependent adult abuse referral: (1) A dependent adult. (2) Abuse as defined in Iowa Code 235B. (3) A caretaker, if applicable. REPORT INFORMATION Name of Dependent Phone ( ) City Street Birth Date State Zip Code 1. Person is a dependent adult because: 2. Type of abuse noted: ! Physical injury ! Sexual offense ! Financial exploitation ! Unrea.

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