Alabama's Department of Human Resources uses this 1-page fillable report to record suspected abuse, neglect or exploitation of an adult for Adult Protective Services. It captures the incident type and location, the person at risk, up to two persons allegedly responsible, their circumstances, the alleged nature and result of the incident, and the reporter's statement. Physicians check a mandated reporter box.
The reporter completes all six sections; Section VI has a checkbox for mandated reporters (physicians, practitioners of the healing arts or caregivers) and the reporter's statement of the incident.
Download the current version from the source each time; forms change without notice.
Report of Adult Suspected to Be Abused, Neglected or Exploited
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The form and its instructions say to keep a copy for your records and email it to DHR Adult Protective Services. You can also call the state's Adult Abuse Hotline to report suspected mistreatment.
The instructions define exploitation as spending, reducing or using a person's property, assets or resources without the express voluntary consent of that person or their legally authorized representative. Theft, misuse of financial authority and demands for funds are examples listed on the form.