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 occurre

  • 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

  • Hotline (side 1) and Safety (side 2) Sheets

Multi-County 2014

Multi-County 2007

Santa Clara County Only
2012

 

San Mateo County Only
2014

 

 

English
Spanish

 

English
Spanish
Russian
Chinese

Vietnamese
Tagalog
Farsi

English
Spanish

 

English
Spanish

 

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