Dhs 1640 form-2026

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43 votes

The document is a confidential report form from the State of Hawaii's Department of Human Services, specifically for reporting suspected abuse, neglect, or exploitation of vulnerable adults. It outlines the process for mandated reporters to document their findings and submit them to Adult Protective Services (APS), including necessary information about the victim, type of harm, alleged perpetrator, and any relevant history or support systems. The form emphasizes the importance of immediate reporting and provides contact details for various APS offices across Hawaii.

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Click ‘Get Form’ to open the dhs 1640 form in the editor.
Begin by filling out the Reporter Information section. Enter your name, agency, title, and contact details. Indicate if you are a mandated reporter.
In the Type of Harm section, check all applicable boxes that describe the suspected abuse or neglect. Provide the date of the incident and location.
Complete the Vulnerable Adult Information section with details such as name, date of birth, address, gender, and any disabilities observed.
Detail any Presenting Concerns of the vulnerable adult and list any Alleged Perpetrators along with their information.
Use the Narrative Information section to describe incidents in detail. Include dates and locations as necessary.
Once completed, save your changes and submit via fax or email as instructed on the last page.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (83 Votes)
2015	4.1 Satisfied (32 Votes)
2014	3.9 Satisfied (43 Votes)

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