Domestic Abuse

Reporting Forms and
Patient Materials

Getting Started

Reporting Procedure

  • Contact Social Work to assist you and counsel patient regarding circumstances and safety
  • Call immediately or ASAP (#s at right):
    Adult
    Police in city where injury occurred
    Elder/
    Dependent Adult
    Police in city where abuse occurred or APS in county of residence
    Child
    Police in city where abuse occurred or CPS in county of residence
    Sexual assault
    Police in city where assault occurred
  • Fill out form (see below) - hand to or fax to agency:
    Adult
    within 2 working days
    Elder/
    Dependent Adult
    within 2 working days
    Child
    within 36 hours
  • Provide patient materials (see below)
    CA law requires that patients be given referral info - can download below or get copy from SW or ED; document!

CA State Abuse Reporting Forms

Patient Materials

USEFUL Contacts

Social Work
SHC 723-5091
LPCH 497-8303

SCAN Team (Suspected Child Abuse/Neglect)
LPCH page operator

Risk Management
723-6824

Security
723-7222

Palo Alto Police
650-329-2413
All state PDs

APS (Adult Protective Services)
Santa Clara 408-975-4900
San Mateo 800-675-8437
All state APS

CPS (Child Protective Services)
Santa Clara 650-493-1186
San Mateo 800-632-4615
All state CPS

SART (Sexual Assault Response Team)
Age 12 or older 408-885-5000
<age 12 408-885-6460

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