California Cal OES 2-920 Suspicious Injury Report

California Penal Code section 11160 requires a health practitioner who treats a wound or physical injury caused by assaultive or abusive conduct, or by a firearm, to phone local law enforcement immediately. The written follow-up goes on Cal OES 2-920 within 2 working days. The form records the patient and injury, the suspect if the patient names one, and the agencies notified.

Who completes it

The health practitioner who provided medical services completes Parts A to C and signs; Part B, the agencies receiving the phone and written reports, is required.

Submitting and payment

How to submit it
Make a telephone report to local law enforcement immediately or as soon as possible, then submit this written report to a local law enforcement agency within 2 working days.
Who pays
There is no fee to file, and the form has no billing section.

Good to know

  • The report is confidential under Penal Code section 11163.2 and used by law enforcement only; the suspect must never get access to the injured person's whereabouts.
  • Part A asks for a SAFE telephone number for the patient and whether they speak English or another language.
  • The California Clinical Forensic Medical Training Center supplies copies of the form and help completing it.
  • Related Cal OES forms include 2-502 for domestic violence exams and 2-602 for elder and dependent adult abuse and neglect exams.

Get the official form

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

Mandated Suspicious Injury Report

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

What injuries require a Cal OES 2-920 report?

Penal Code 11160 covers any wound or physical injury inflicted by assaultive or abusive conduct, or by means of a firearm, when a health practitioner provides medical services for it within the scope of their employment.

What goes in Part A of the Cal OES 2-920?

Part A covers the patient: name, birth date, a safe phone number, address, language, the date, time and location of injury, the patient's own description of the incident, the suspect's name and relationship if identified, and a description of the injury, physical findings and labs.