After phoning MDHHS Centralized Intake about suspected child abuse or neglect, a Michigan mandated reporter sends this written follow-up within 72 hours, as Section 3(1) of the Child Protection Law (1975 PA 238) requires. The DHS-3200 (Rev. 8-23) records the children, primary caregiver, alleged perpetrator and what happened, plus examination findings when medical personnel have examined the child.
The reporting person completes the intake, child, caregiver, perpetrator, abuse or neglect, and reporting source sections. Only medical personnel complete the medical section (Section 7) on examination findings, injuries and prior history, which the physician signs.
Download the current version from the source each time; forms change without notice.
Report of Actual or Suspected Child Abuse or Neglect
Report of Actual or Suspected Child Abuse or Neglect (Spanish) DHS-3200-SP
This form is a Word template, not a PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Yes. MDHHS posts a Spanish DHS-3200-SP as a Word template alongside the English form, and an Arabic DHS-3200-AR as a PDF on its abuse and neglect forms page. Every version serves as the written follow-up to a phone report to Centralized Intake.
Section 6 lists RS codes. Hospital or clinic physicians and physician assistants use code 15, private physicians and PAs code 30, hospital or clinic personnel 13, non-school nurses 21 and psychologists 32. Enter the code with your organization and its contact details.
A summary of the physical examination with lab and x-ray results (attach the documentation), the injuries present, whether they are concerning, highly concerning or diagnostic of physical abuse, whether they match the caretaker's history, what they caused, any prior abuse, prior hospitalizations, and the physician's name and signature.