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Florida Abuse Hotline Fax Transmittal Form

The Florida Abuse Hotline accepts written reports by fax on this two-page DCF transmittal form, covering abuse, abandonment or neglect of a child and abuse, neglect or exploitation of a vulnerable adult under Chapters 39 and 415, Florida Statutes. A clinician can use it when the situation does not need immediate attention. It describes the victim, the person responsible and what happened.

Who completes it

The reporter completes the whole form. The reporter information block is required for mandatory reporters, and the rest covers the victim's location and household, the persons responsible and the incident.

Submitting and payment

How to submit it
Fax the completed form to the Florida Abuse Hotline fax number printed on it, one family per fax. If anyone is in immediate danger, call 911 and then the Hotline's toll-free line instead of faxing.
Who pays
DCF lists no fee or payment for reporting to the Hotline.

Good to know

  • Do not attach medical notes, case files, arrest reports or similar documents; the form asks for a written description of the incident instead.
  • For an adult victim, describe the disability and how it impairs the person's ability to care for or protect themselves. For a child, list the other children in the home.
  • Describe what happened, when and where, how often it occurs, and the injuries or threat of harm, and list others who may know about the situation.
  • DCF's online Mandated Reporter Portal is the other written option and, like the fax form, is not meant for situations needing immediate attention.

Get the official form

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

Florida Abuse Hotline Fax Transmittal Form To Report Abuse/Abandonment/Neglect/Exploitation

Official pagePDF

Fill it with Vero

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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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

Can I fax medical records with a Florida Abuse Hotline report?

No. The form states in capitals not to send copies of medical notes, case files, arrest reports or similar documents. Summarize the relevant findings in the Description of Incident section instead, including what happened, when and where, how often, and the injuries or threat of harm.

Should one fax report cover more than one family?

No. The Hotline asks reporters not to fax allegations for multiple families at one time, because reports submitted one at a time are likely to be processed faster. Use a separate transmittal form for each family, listing up to five household members and three persons responsible on each.

Do mandatory reporters have to give their name on the fax form?

Yes. The reporter information section, with name, occupation, agency and contact details, is required for mandatory reporters under Chapters 39 and 415, Florida Statutes. DCF also asks fax reporters to include a contact telephone or fax number with their detailed written report.