Reporting Forms and Patient Materials

Getting Started

• If you know you need to report
  see (below) Reporting Procedure
• If you are not sure:
  contact SW, Risk, SCAN team (#s at right)
  see SHC/LPCH policy manuals 
  see Stanford websites: domestic, elder, child abuse or human trafficking
• Helpful aids
  CA abuse law easy summary
  Adult sexual assault flow chart
  CA sexual intercourse with a minor reporting chart

Reporting Procedure

• Contact Social Work to assist you and counsel patient regarding circumstances and safety
• Call immediately or ASAP (#s at right):

• Fill out form (see below) - hand to or fax to agency:

• 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

• Adult 
  "Suspicious Injury Report" Calema 2-920 dated 4/09
  Calema 2-920 Instructions
  Adult body map (CA law recommended, not required)
• Elder/Dependent Adult
  "Suspected Dependent Adult/Elder Abuse" SOC 341 dated 3/15
  Adult body map (CA law recommended, not required)
• Child
  "Suspected Child Abuse Report" SS 8572 dated 4/17
  Child body map (CA law recommended, not required)

Patient Materials

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

• Parent Handouts 
  "Abuse or Violence at Home Affects your Children"
  "Abuse or Violence at Home Affects your Children" Spanish"
  "Abuse or Violence at Home Affects your Children" Vietnamese
• Teen Handouts (age 13-17)
  "Healthy Relationships"
  "Healthy Relationships" Spanish