Missouri Adult Protective Services Report — Elder/Disabled Adult Abuse, Neglect, or Financial Exploitation

MISSOURI ADULT PROTECTIVE SERVICES REPORT — ELDER / DISABLED ADULT ABUSE, NEGLECT, OR FINANCIAL EXPLOITATION

STATUTORY REFERENCE: RSMo §§ 192.2400 to 192.2505

HOTLINE: 1-800-392-0210 (24/7 intake)

ONLINE: https://moapss.health.mo.gov/

TABLE OF CONTENTS

1. Reporter Identification
2. Mandatory Reporter Status
3. Eligible Adult (Alleged Victim) Identification
4. Alleged Perpetrator Information
5. Type of Reportable Conduct
6. Narrative of Suspected Abuse, Neglect, or Exploitation
7. Risk and Urgency Assessment
8. Witnesses and Other Sources
9. Documentary Evidence Attached
10. Prior Reports and Agency Involvement
11. Hotline Confirmation
12. Reporter Certification, Immunity, and Confidentiality
13. Cover Transmittal to DHSS / Senior & Disability Services
14. Missouri Practice Notes
15. Sources and References

1. REPORTER IDENTIFICATION

2. MANDATORY REPORTER STATUS

Check the basis on which the reporter is making this report:

• ☐ Mandatory reporter under RSMo § 192.2405. Specific category (check):
• ☐ Physician / nurse / nurse practitioner / physician assistant
• ☐ Dentist / chiropractor / optometrist / podiatrist
• ☐ Psychologist / social worker / professional counselor / marriage-and-family therapist
• ☐ Hospital / clinic employee
• ☐ Long-term care facility employee
• ☐ Adult day-care center employee
• ☐ In-home services provider / home-health agency employee
• ☐ Emergency Medical Services personnel
• ☐ Coroner / medical examiner
• ☐ Peace officer / law-enforcement officer
• ☐ Mental-health professional / facility employee
• ☐ Other statutory category: [____]
• ☐ Permissive reporter (any person with reasonable cause to suspect)

3. ELIGIBLE ADULT (ALLEGED VICTIM) IDENTIFICATION

An "eligible adult" under RSMo § 192.2400 means a person 60 years of age or older, or an adult between the ages of 18 and 59 with a disability as defined by statute, who is unable to protect his or her own interests or unable to adequately perform or obtain services necessary to meet essential human needs.

Eligibility Basis (check):

• ☐ Age 60 or older
• ☐ Age 18-59 with disability rendering inability to protect interests or meet essential needs

4. ALLEGED PERPETRATOR INFORMATION

If multiple perpetrators are alleged, complete one block per person and attach additional sheets.

5. TYPE OF REPORTABLE CONDUCT

Check ALL that apply (definitions per RSMo § 192.2400):

• ☐ Abuse — infliction of physical, sexual, or emotional injury or harm; intimidation; or unreasonable confinement
• ☐ Physical
• ☐ Sexual
• ☐ Emotional / psychological
• ☐ Unreasonable confinement / isolation
• ☐ Neglect — failure of caregiver or self-neglect resulting in deprivation of services necessary to maintain physical or mental health
• ☐ Caregiver neglect
• ☐ Self-neglect
• ☐ Financial Exploitation — illegal or improper use of an eligible adult's funds, property, or assets
• ☐ Theft / misuse of funds, accounts, credit
• ☐ Forgery / unauthorized signing
• ☐ Misuse of POA / fiduciary breach
• ☐ Undue influence / coercion in transfers, deeds, beneficiary changes, marriage
• ☐ Predatory loan / scam / online or phone fraud
• ☐ Bullying (RSMo § 192.2400(2))
• ☐ Abandonment
• ☐ Other (describe): [____]

6. NARRATIVE OF SUSPECTED ABUSE, NEGLECT, OR EXPLOITATION

Provide a detailed factual narrative. Use only what was personally observed or reliably learned; clearly label hearsay or second-hand information.

Date(s) of Incident(s) or Pattern: [__/__/____] to [__/__/____]

Location: [________________________________]

Description (chronological):

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

Observed Injuries or Conditions:

Statements by the Eligible Adult (verbatim where possible):

[____________________________________________________________]

[____________________________________________________________]

Statements by Alleged Perpetrator:

[____________________________________________________________]

Reporter's Basis for Reasonable Cause to Suspect:

[____________________________________________________________]

7. RISK AND URGENCY ASSESSMENT

Reporter's Recommended Urgency Level:

• ☐ EMERGENCY — call 911 or law enforcement now (and 1-800-392-0210)
• ☐ URGENT — same-day APS response requested
• ☐ ROUTINE — standard intake response

8. WITNESSES AND OTHER SOURCES

9. DOCUMENTARY EVIDENCE ATTACHED

• ☐ Photographs of injuries / conditions (date-stamped)
• ☐ Medical records / clinical notes
• ☐ Bank statements showing suspicious activity
• ☐ Cancelled checks / wire-transfer records
• ☐ Recent deeds / titles / beneficiary changes
• ☐ Power-of-attorney documents
• ☐ Will / trust amendments
• ☐ Text messages / emails / voicemails (transcribed where possible)
• ☐ Police reports / incident numbers
• ☐ Facility incident reports
• ☐ Other: [____]

10. PRIOR REPORTS AND AGENCY INVOLVEMENT

11. HOTLINE CONFIRMATION

12. REPORTER CERTIFICATION, IMMUNITY, AND CONFIDENTIALITY

I certify that I have made this report in good faith based on personally observed facts and reasonably reliable information. I understand that pursuant to RSMo § 192.2475 a person who reports in good faith is immune from any civil or criminal liability for making the report or for testifying in any related proceeding, except for liability for perjury and except where the reporter has acted negligently, recklessly, in bad faith, or with malicious purpose.

I further understand that the reporter's identity is protected from disclosure except as authorized by law (RSMo § 192.2435), and that knowingly making a false report may itself give rise to civil and criminal liability.

Reporter Signature: [________________________________]

Print Name: [________________________________]

Date: [__/__/____]

13. COVER TRANSMITTAL TO DHSS / SENIOR & DISABILITY SERVICES

[DATE]

Missouri Department of Health and Senior Services
Division of Senior and Disability Services
Adult Protective Services
912 Wildwood, P.O. Box 570
Jefferson City, MO 65102

Re: Written Supplement to Hotline Report — [ELIGIBLE ADULT NAME], DOB [__/__/____], Hotline Confirmation [#]

Dear Investigator:

This written report supplements the oral hotline report placed at [___ : ___ ] on [__/__/____] at 1-800-392-0210 concerning suspected [abuse / neglect / financial exploitation] of the above-named eligible adult. The narrative, witness list, and documentary attachments are provided to assist your investigation under RSMo §§ 192.2400 to 192.2505.

The reporter requests, where consistent with statute and agency procedure: (a) confirmation of receipt, (b) assignment of an investigator and case number, (c) notification of investigative outcome to the extent permitted by RSMo § 192.2435, and (d) coordination with [law enforcement / Long-Term Care Ombudsman / facility licensing] as appropriate.

Please contact the undersigned at [TELEPHONE] or [EMAIL] for any clarification.

Sincerely,

[________________________________]

[REPORTER NAME, TITLE]

[ORGANIZATION]

[ADDRESS]

Telephone: [________________________________]

Email: [________________________________]

Enclosures: Completed APS report; photographs; financial records; medical records; correspondence.

14. MISSOURI PRACTICE NOTES

• Single statewide hotline. All reports of suspected abuse, neglect, or exploitation of eligible adults are routed through 1-800-392-0210 or https://moapss.health.mo.gov/. Hotline answers 7 a.m.–8 p.m. with 24/7 online intake and 24/7 voicemail; emergency cases involving imminent risk require concurrent 911 notification.
• Mandatory reporter scope. RSMo § 192.2405 enumerates an extensive list of professionals; when in doubt, treat the duty as triggered. RSMo § 565.188 makes failure to report a Class A misdemeanor.
• Definition of "eligible adult." Persons 60+ OR adults 18-59 with a disability that renders them unable to protect their own interests or meet essential needs. Mere age over 60 is sufficient — disability is not required for that prong.
• Good-faith immunity. RSMo § 192.2475 provides civil and criminal immunity, with narrow exceptions for perjury, negligence, recklessness, bad faith, or malice. Document the basis of "reasonable cause" contemporaneously.
• Confidentiality. Reporter identity is statutorily protected (RSMo § 192.2435). Investigative materials are confidential subject to limited statutory disclosures.
• Criminal counterparts. RSMo §§ 565.180 (1st-degree elder abuse), 565.182, 565.184, and 570.145 (financial exploitation) create criminal exposure for perpetrators, including class A felony liability where serious physical injury is inflicted.
• Long-term care facilities. Where the eligible adult resides in a licensed long-term care facility, also notify the Missouri Long-Term Care Ombudsman (1-800-309-3282) and consider parallel Section 1150B / federal NHRA reporting where statutorily triggered.
• In-home and home-health services. RSMo § 660.300 et seq. imposes reporting duties specific to in-home services and home-health workers and creates the Employee Disqualification List (EDL) administered by DHSS.
• Concurrent law enforcement. APS investigates and provides protective services; criminal investigation lies with law enforcement. Both can — and frequently should — proceed in parallel.
• Capacity and self-determination. APS services are voluntary for capacitated adults; an eligible adult may refuse services even where the report is substantiated. Where capacity is compromised, guardianship/conservatorship under RSMo Chapter 475 may be necessary in addition to APS intervention.

15. SOURCES AND REFERENCES

• Missouri Adult Abuse & Neglect Hotline: 1-800-392-0210
• DHSS APS Online Portal: https://moapss.health.mo.gov/
• DHSS Stop Adult Abuse: https://health.mo.gov/safety/abuse/
• DHSS Adult Protective Services overview: https://health.mo.gov/safety/abuse/adult-protective-services.php
• RSMo § 192.2400 (definitions): https://revisor.mo.gov/main/OneSection.aspx?section=192.2400
• RSMo § 192.2405 (mandatory reporters): https://revisor.mo.gov/main/OneSection.aspx?section=192.2405
• RSMo § 192.2475 (immunity): https://revisor.mo.gov/main/OneSection.aspx?section=192.2475
• RSMo §§ 565.180-188 (criminal elder abuse): https://revisor.mo.gov/main/OneChapterRng.aspx?tb1=565.180+to+565.188
• RSMo § 570.145 (financial exploitation): https://revisor.mo.gov/main/OneSection.aspx?section=570.145
• 13 CSR 15-7.020 (DHSS investigation rules): https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c15-7.pdf
• Missouri Long-Term Care Ombudsman: 1-800-309-3282 / [email protected]

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Mandatory reporting obligations attach as soon as reasonable cause to suspect arises and require immediate action via the statewide hotline. An attorney licensed in Missouri must review and customize this report where institutional, employment, or litigation consequences are anticipated.