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Massachusetts Elder Abuse Mandated Reporter Form

Massachusetts mandated reporters who call the Elder Abuse Hotline about suspected abuse, neglect, financial exploitation or self-neglect of a community-dwelling adult aged 60 or older must follow up with this written form within 48 hours. It goes to the local Protective Service Agency, which reviews reports, usually the same day, and decides whether Adult Protective Services will investigate.

Who completes it

The mandated reporter, such as a physician, physician assistant, nurse, dentist, podiatrist, psychologist, physical or occupational therapist or social worker, completes and signs the whole form. The older adult and family complete no part.

Submitting and payment

How to submit it
Call the 24-hour Elder Abuse Hotline first (always by phone in an emergency), then send the form within 48 hours to the designated Protective Service Agency for the adult's area, found at mass.gov/protectolderadults. Reporting through the online system instead replaces both the call and this form.
Who pays
AGE lists no fee; reporting is a mandated reporter duty under M.G.L. c.19A, and mandated reporters who fail to report may be fined.

Good to know

  • If you file online, you do not call and you do not complete this form; online reports are treated like phone reports, with an email confirmation if you give an address.
  • The form, updated April 2026, asks whether medical treatment is needed immediately, whether the reporter believes it is an emergency, and about any additional safety concerns.
  • It also asks whether the older adult knows a report is being made, uses assistive communication devices, needs an interpreter, or needs disability accommodations.
  • Investigations finish within 30 days, and mandated reporters learn the findings within 45 calendar days of the report. APS proceeds with a plan only with the older adult's consent.

Get the official form

Download the current version from the source each time; forms change without notice.

Abuse Against Older Adults Mandated Reporter Form

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Do I need this form if I reported elder abuse online?

No. Massachusetts AGE says that if you file a report online you do not need to call and do not need to fill out the Elder Abuse Mandated Reporter Form. Online reports are referred to the local Protective Service Agency like phone reports. Use the phone in an emergency, then send the form within 48 hours.

Am I protected from liability for reporting?

The form's cover letter quotes M.G.L. c.19A: a mandated reporter is not liable in any civil or criminal action for making the report, and other reporters are protected if the report was made in good faith. Employers may not penalize an employee for reporting, while mandated reporters who fail to report may be fined.

Which older adults does this form cover?

Adults aged 60 or older who live in the community. AGE states that Adult Protective Services can only investigate abuse where the person is 60 or over and lives in the community. Reportable abuse includes physical, sexual and emotional abuse, caregiver neglect, financial exploitation and self-neglect.