The results of all investigations must be reported within five working days of the initial notification to the department.
With serious bodily injury: certain providers must report a reasonable suspicion of a crime with resulting serious bodily injury within 2-hours.
Without serious bodily injury: certain providers must report a reasonable suspicion of a crime without resulting serious bodily injury within 24-hours.
Failure to comply: failure to comply may result in a report to the agency having jurisdiction for compliance enforcement.
Accused individual: Social Security # (required).
| Question | Answer |
|---|---|
| Form Name | DHSR/HCPR Form No. 4501 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min |
| Edition | 06/24/2014 |
| Other names | 4501, DHSR 4501, HCPR 4501, DHSR/HCPR Form No. 4501, 24-Hour Initial Report |
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