- adult maltreatment form

Category

adult maltreatment form -


MAIL THE COMPLETED FORM TO: Adult Maltreatment Central Registry - Slot W240 PO Box 1437 Little Rock, AR 72203 Email: [email protected] Fax: 501-682-6393 ARKANSAS DEPARTMENT OF HUMAN SERVICES. REQUEST FOR ADULT MALTREATMENT REGISTRY INFORMATION. Print all information in ink. Name Date of Birth. ADE Form Effective Date (01/15/13) AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION. By the Arkansas Child Maltreatment Central Registry. Applicant Instructions: Complete this form, have it notarized, and submit a preprinted check or a U.S. money order for $10.00 made payable to the Arkansas Department of Human Services.

Minnesota’s state policy is to provide safe environments and services for vulnerable adults and protective services for vulnerable adults who have been maltreated. The Minnesota Adult Abuse Reporting Center (MAARC) provides a toll-free number, 1-844-880-1574, the general public can call to report suspected maltreatment of vulnerable adults. ARKANSAS DEPARTMENT OF HUMAN SERVICES. AUTHORIZATION FOR ADULT MALTREATMENT CENTRAL REGISTRY. Print all information in ink. Name Date of Birth Maiden and/or Any Names Formerly Used Social Security Number.

Minnesota Adult Abuse Reporting Center (MAARC) Mandated Reporter Form DISCLOSURE: Prior to any disclosure refer to MN Stat. sec. 13.02 and MN Stat. sec. 626.557, Subd. 12b Refer to the MAARC Mandated Reporter Guide for information on using the web-based reporting system. Reporting maltreatment. A mandated reporter who suspects a vulnerable adult was maltreated is required to report to MAARC.. A report means a statement concerning all the circumstances known to the reporter at the time the statement is made surrounding the alleged or .

ARKANSAS DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR ADULT MALTREATMENT CENTRAL REGISTRY Print all information in ink Name Date of Birth Maiden and/or Any Names Formerly Used Social Security Number Current Address (Street, City, State, Zip) List all previous addresses for the past five years Dates (From/To). Adult Maltreatment Report, paper form #2494, to report investigative findings. DHS will obtain this information from counties on a monthly basis utilizing the monthly.