Dhr Fcs Form 1593 PDF Details

In the State of Alabama, the Department of Human Resources mandates the use of the DHR-FCS-1593 form as a critical tool in the fight against child abuse and neglect. This comprehensive form serves as the initial written report for suspected cases, requiring the reporter to detail all relevant information about the child or children involved, as well as any individuals alleged to be responsible for the abuse or neglect. Through a structured breakdown, the form guides the reporter through several sections, including the identification of the child or children allegedly abused or neglected, other persons living with the child, and the person or persons allegedly responsible for the abuse or neglect. Furthermore, it prompts the reporter to describe the allegations of abuse or neglect, detailing what happened, how it affected the children, and when it occurred. Additionally, it offers space for providing information about witnesses or others who may have knowledge about the child's or family's situation. The form also inquires whether the reporter has previously communicated these allegations verbally to the Department of Human Resources or law enforcement authorities. The detailed instructions on the back aim to ensure clarity and compliance with Alabama's Child Abuse/Neglect Reporting Law, underscoring the state's commitment to protecting its most vulnerable citizens.

QuestionAnswer
Form NameDhr Fcs Form 1593
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdhr reporting form alabama, form 1593 for alabama, dhr reporting form, alalbama dhr 1593

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STATE OF ALABAMA DEPARTMENT OF HUMAN RESOURCES

WRITTEN REPORT OF SUSPECTED CHILD ABUSE/NEGLECT

Please print or type all known information. The Child Abuse/Neglect Reporting Law and instructions are explained on the back of this form.

SECTION I – CHILDREN ALLEGEDLY ABUSED OR NEGLECTED

NAME (First, Middle Initial, Last)

1._________________________________________________________________

2._________________________________________________________________

3._________________________________________________________________

4._________________________________________________________________

5._________________________________________________________________

6._________________________________________________________________

SEX

ETHNICITY

DATE OF BIRTH/AGE

M F ________________ ____________________

M F ________________ ____________________

M F ________________ ____________________

M F ________________ ____________________

M F ________________ ____________________

M F ________________ ____________________

ADDRESS _______________________________________________________________________________________________________________________

 

Street Address

City

State

Zip

Telephone Number

 

 

SECTION II – OTHER PERSONS LIVING WITH THE CHILDREN (Include parents/custodians and other children in the home)

 

 

 

NAME (First, Middle Initial, Last)

DATE OF BIRTH / AGE

ETHNICITY

RELATIONSHIP TO

 

 

 

 

 

THE CHILDREN

1.

________________________________________________________________

____________________

________________ _________________

2.

________________________________________________________________

____________________

________________ _________________

3.

________________________________________________________________

____________________

________________ _________________

4.

________________________________________________________________

____________________

________________ _________________

5.

________________________________________________________________

____________________

________________ _________________

6.________________________________________________________________ ____________________ ________________ _________________

SECTION III – PERSON(S) ALLEGEDLY RESPONSIBLE FOR THE ABUSE OR NEGLECT

 

 

NAME (First, Middle Initial, Last)

 

SEX

 

ETHNICITY

DATE OF BIRTH / AGE

1.

_________________________________________________________________

M

F

________________

____________________

 

_________________________________________________________________

______________________________________________________

 

Street Address

City

State

Zip

Telephone Number

Relationship To Children Allegedly Abused/Neglected

2.

_________________________________________________________________

M

F

________________

____________________

 

_________________________________________________________________

______________________________________________________

 

Street Address

City

State

Zip

Telephone Number

Relationship To Children Allegedly Abused/Neglected

SECTION IV – ABUSE OR NEGLECT ALLEGATIONS (Describe what happened, how it affected the children, and the date(s) occurred, if known.

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

Did you see the abuse or neglect when it occurred?

Yes

No If no, how did you find out about it? ______________________________________

Please identify other people who witnessed the abuse/neglect or who may have information about the child’s or family’s situation.

Name

Address

Telephone #

Relationship to Children

1. ________________________________________

__________________________________________

______________

________________________

2. ________________________________________

__________________________________________

______________

________________________

SECTION V - OTHER PERTINENT INFORMATION

________________________________________________________________________________________________________________________________

SECTION VI - REPORTER

_________________________________________________________________________________________________________________________________________________

Name

Address

Telephone Number

Title/Agency/Relationship To Children

Did you verbally report the allegations to the Department of Human Resources or law enforcement?

Yes (specify to whom in section below)

No

______________________________________________

_____________________________________________________

________________________

Name

Name of County DHR, Police Department, or Sheriff’s Department

Date Reported

Signature _______________________________________________________________________ Date ____________________________________________

For DHR Use Only County _______________________________ Case #____________________________ Date Report Received _____________________

DHR-FCS-1593 (September 2002)

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dhr reporting form conclusion process described (portion 1)

2. Just after filling out the previous part, go to the subsequent step and enter the essential details in these blanks - Telephone Number Street Address, State, City, Zip, Relationship To Children Allegedly, Telephone Number Street Address, State, City, Zip, Relationship To Children Allegedly, SECTION IV ABUSE OR NEGLECT, Did you see the abuse or neglect, Yes, If no how did you find out about, and Please identify other people who.

Step number 2 of completing dhr reporting form

It is easy to make a mistake when filling in the Relationship To Children Allegedly, so make sure you go through it again before you decide to send it in.

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Date Reported, Signature Date, and Name in dhr reporting form

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