2005 California Welfare and Institutions Code Sections 15658 Article 9. Reporting Forms

15658.  (a) (1) The written abuse reports required for the reporting
of abuse, as defined in this chapter, shall be submitted on forms
adopted by the State Department of Social Services after consultation
with representatives of the various law enforcement agencies, the
California Department of Aging, the State Department of Developmental
Services, the State Department of Mental Health, the bureau,
professional medical and nursing agencies, hospital associations and
county welfare departments.  These reporting forms shall be
distributed by the county adult protective services agencies and the
long-term care ombudsman programs.  This reporting form may also be
used for documenting the telephone report of a known or suspected
instance of abuse of an elder or dependent adult by the county adult
protective services agency, local ombudsman program, and local law
enforcement agencies.
   (2) The forms required by this section shall contain the following
items:
   (A) The name, address, telephone number, and occupation of the
person reporting.
   (B) The name and address of the victim.
   (C) The date, time, and place of the incident.
   (D) Other details, including the reporter's observations and
beliefs concerning the incident.
   (E) Any statement relating to the incident made by the victim.
   (F) The name of any individuals believed to have knowledge of the
incident.
   (G) The name of the individuals believed to be responsible for the
incident and their connection to the victim.
   (b) (1) Each county adult protective services agency shall report
to the State Department of Social Services monthly on the reports
received pursuant to this chapter.  The reports shall be made on
forms adopted by the department.  The information reported shall
include, but shall not be limited to, the number of incidents of
abuse, the number of persons abused, the type of abuse sustained, and
the actions taken on the reports.  For purposes of these reports,
sexual abuse shall be reported separately from physical abuse.
   (2) The county's report to the department shall not include
reports it receives from the long-term care ombudsman program
pursuant to subdivision (c).
   (3) The department shall refer to the bureau monthly data
summaries of the reports of elder and dependent adult abuse, neglect,
abandonment, isolation, and financial abuse, and other abuse it
receives from county adult protective services agencies.
   (c) Each long-term care ombudsman program shall report to the
office of the Long-Term Care Ombudsman of the California Department
of Aging monthly on the reports it receives pursuant to this chapter
with a copy sent to the county adult protective services agency.  The
office of the state ombudsman shall submit a summarized quarterly
report to the department based on the monthly reports submitted by
local long-term care ombudsman programs.  The reports shall be on
forms adopted by the department and the office of the state
ombudsman.  The information reported shall include, but shall not be
limited to, the number of incidents of abuse, the numbers of persons
abused, the type of abuse, and the actions taken on the reports.  For
purposes of these reports, sexual abuse shall be reported separately
from physical abuse.