Iowa HHS form 470-2441 is the written format for reporting suspected dependent adult abuse to the Centralized Services Intake Unit (CSIU). Mandatory reporters must report within 24 hours of reasonably believing a dependent adult has been abused, usually by phone, and this form is the written route when no oral report will be made. It documents why the person is a dependent adult, the type of abuse and the caretaker.
The mandatory reporter completes the whole form, explains why the person is a dependent adult and why the named caretaker is a caretaker, lists other mandatory reporters who know of the abuse, and signs it. Intake staff supply the report number.
Download the current version from the source each time; forms change without notice.
Suspected Dependent Adult Abuse Report
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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Iowa HHS now states that a written report of suspected abuse is no longer required when an oral report is made within 24 hours. Form 470-2441 remains available for reporters who report in writing instead, and it must be submitted within 24 hours if no oral report will be made.
Yes. Iowa HHS must tell the reporter orally within 24 hours whether the report was accepted or rejected, followed by a written Notice of Intake Decision. For dependent adult abuse, an outcome notice later reports the assessment results. Mandatory reporters must give their name and address when reporting.
Iowa Code 235B.3(11) gives dependent adult abuse reporters immunity for making a report or assisting, and for good-faith participation in related judicial proceedings. Employers and supervisors may not apply policies or work rules that interfere with a mandatory reporter making a report.