Texas Adult Protective Services Report (DFPS APS — Tex. Hum. Res. Code Ch. 48)

TEXAS ADULT PROTECTIVE SERVICES — REPORT OF SUSPECTED ABUSE, NEGLECT, OR EXPLOITATION

EMERGENCY? Call 9-1-1 immediately.
DFPS Statewide Intake (APS): 1-800-252-5400 (24 hours / 7 days)
Online report: https://www.txabusehotline.org
Suspected abuse INSIDE a regulated facility (NF, ALF, ICF/IID, HCS, home health): HHSC Long-Term Care Regulatory: 1-800-458-9858

TABLE OF CONTENTS

1. Reporter Information
2. Mandatory-Reporter Acknowledgments
3. Alleged Victim (Elderly or Disabled Adult)
4. Alleged Perpetrator(s)
5. Type of Abuse, Neglect, or Exploitation
6. Narrative of Events
7. Evidence and Witnesses
8. Risk and Safety Assessment
9. Report Submission Log
10. Follow-Up and Cooperation with DFPS
11. Confidentiality and Immunity Acknowledgment
12. Signature
13. Texas Practice Notes
14. Sources and References

1. REPORTER INFORMATION

2. MANDATORY-REPORTER ACKNOWLEDGMENTS

Reporter acknowledges (initial each line):

• [____] I have cause to believe an elderly person (age 65 or older) or a person with a disability is in the state of abuse, neglect, or exploitation as defined by Tex. Hum. Res. Code § 48.002.
• [____] I understand that Tex. Hum. Res. Code § 48.051 imposes an immediate duty to report on any person, including persons whose communications are otherwise privileged (attorney, clergy, medical practitioner, social worker, mental-health professional, employee or member of a licensing board).
• [____] I understand that knowing failure to report is a Class A misdemeanor under § 48.052 (up to $4,000 fine and/or up to 1 year jail).
• [____] I understand that knowingly false reports are a Class A misdemeanor under § 48.053.
• [____] I understand that I am immune from civil and criminal liability for a good-faith report under § 48.054.

3. ALLEGED VICTIM (ELDERLY OR DISABLED ADULT)

4. ALLEGED PERPETRATOR(S)

5. TYPE OF ABUSE, NEGLECT, OR EXPLOITATION

Check all that apply (Tex. Hum. Res. Code § 48.002):

• ☐ Physical abuse (intentional infliction of injury, unreasonable confinement, intimidation, or punishment with resulting harm or pain; sexual abuse)
• ☐ Emotional / verbal abuse (causing emotional pain or distress)
• ☐ Sexual abuse (any non-consensual sexual contact)
• ☐ Caregiver neglect (failure of a caregiver to provide goods or services necessary to avoid physical or emotional harm or pain)
• ☐ Self-neglect (an adult's inability, due to physical or mental impairment, to perform essential self-care tasks)
• ☐ Financial exploitation (illegal or improper act/process by another using the resources of an elderly person or person with a disability for monetary or personal benefit, profit, or gain) — Tex. Hum. Res. Code § 48.002(a)(3); see also Tex. Penal Code Chapter 32
• ☐ Medication mismanagement / chemical restraint
• ☐ Abandonment
• ☐ Other (describe): [________________________________]

6. NARRATIVE OF EVENTS

Provide a detailed factual narrative. Use objective, observable facts. Distinguish between what you personally observed, what was reported to you, and what you infer.

Date(s) of incident or pattern: [__/__/____] to [__/__/____]

Location: [________________________________]

Narrative:

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

[________________________________________________________________________]

Most recent observation date/time: [__/__/____] at [__:__ AM/PM]

Specific injuries, conditions, or financial transactions observed: [________________________________]

7. EVIDENCE AND WITNESSES

7.1 Physical / Documentary Evidence

• ☐ Photographs (number: [____])
• ☐ Medical records / discharge summaries
• ☐ Bank statements, checks, wire-transfer records
• ☐ Power of attorney, guardianship, or trust documents
• ☐ Real-estate deeds / title transfers
• ☐ Surveillance video
• ☐ Text messages / emails / voicemails
• ☐ Police reports
• ☐ Other: [________________________________]

7.2 Witnesses

8. RISK AND SAFETY ASSESSMENT

• Is the alleged victim in immediate danger? ☐ Yes ☐ No
• Is medical attention required now? ☐ Yes ☐ No
• Has law enforcement been contacted? ☐ Yes — Agency: [____], Report #: [____] ☐ No
• Does the victim have capacity to consent to APS services (best estimate)? ☐ Yes ☐ No ☐ Unknown
• Does the alleged perpetrator currently reside with or have unsupervised access to the victim? ☐ Yes ☐ No
• Are firearms or other weapons in the household? ☐ Yes ☐ No ☐ Unknown
• Is there a history of prior reports? ☐ Yes ☐ No ☐ Unknown

9. REPORT SUBMISSION LOG

10. FOLLOW-UP AND COOPERATION WITH DFPS

DFPS will assign an APS specialist who may:

• Make a face-to-face contact with the alleged victim within statutory priority timeframes (Priority 1 — within 24 hours; Priority 2 — within 72 hours; lower priorities — within 14 days; see 40 TAC Chapter 705).
• Coordinate emergency services, medical care, mental-health services, or protective services.
• Petition for emergency protective orders or guardianship under Tex. Hum. Res. Code §§ 48.208–48.212 and Tex. Est. Code Title 3.
• Refer the matter to law enforcement or the Office of the Attorney General Elder Fraud unit.

I will cooperate with the APS investigation and supply additional information upon request.

Authorized contact for follow-up:

11. CONFIDENTIALITY AND IMMUNITY ACKNOWLEDGMENT

The identity of a reporter under Tex. Hum. Res. Code § 48.101 is confidential and is not subject to disclosure except as provided by statute. APS records are confidential under § 48.123. Good-faith reporters are immune from civil and criminal liability under § 48.054. This immunity does not apply where the reporter acted in bad faith or with malicious purpose. By signing below, the reporter affirms that the information provided is, to the best of the reporter's knowledge, true and given in good faith.

12. SIGNATURE

Reporter signature: [________________________________]

Print Name: [________________________________]

Title / Profession: [________________________________]

Date: [__/__/____]

(Optional) Notary acknowledgment:

State of Texas, County of [________________________________]

Sworn to and subscribed before me on [__/__/____].

[________________________________]

Notary Public — State of Texas

(My Commission Expires: [_______________])

13. TEXAS PRACTICE NOTES

• Universal duty. Texas's reporting statute is broader than many states; it is not limited to a list of professionals. Any "person having cause to believe" must report. Tex. Hum. Res. Code § 48.051(a).
• Privilege override. Section 48.051(c) abrogates most professional privileges (attorney-client, clergy, physician-patient, mental-health-patient) for purposes of the report. Confirm current statutory text; narrow exceptions exist.
• Definitions. Texas defines an "elderly person" as 65 or older; a "person with a disability" is broadly defined as a person 18 years or older with a physical or mental condition that substantially impairs the person's ability to provide adequately for the person's own care or protection (Tex. Hum. Res. Code § 48.002).
• Where APS jurisdiction ends and HHSC begins. APS investigates abuse, neglect, and exploitation of elderly or disabled persons in the COMMUNITY. Allegations involving residents of nursing facilities, assisted-living facilities, ICFs/IID, HCS group homes, day-activity programs, or home-health agencies are investigated by HHSC Long-Term Care Regulatory and (in state-operated facilities) by HHSC Provider Investigations. Routing the report to the wrong agency does not satisfy the statutory duty if not promptly redirected; calling 1-800-252-5400 is the safe default — DFPS will redirect.
• Long-Term Care Ombudsman. Although not an investigative agency, the Ombudsman (1-800-252-2412) is a parallel resource for nursing-facility and assisted-living residents and works alongside HHSC Regulatory.
• Criminal exposure. In addition to civil/regulatory action, abuse, neglect, or exploitation can support prosecution under Tex. Penal Code § 22.04 (injury to elderly individual — first- or second-degree felony depending on intent and harm) and Tex. Penal Code Chapter 32 (theft, misapplication of fiduciary property, exploitation of child, elderly or disabled individual under § 32.53 — financial exploitation; third- to first-degree felony based on amount).
• Emergency protective orders and guardianship. APS may petition for emergency removal under Tex. Hum. Res. Code § 48.208. For longer-term protection, consider Tex. Est. Code guardianship or, where the adult retains capacity, supported decision-making agreements (Tex. Est. Code Chapter 1357).
• Reports involving financial institutions. Texas Finance Code §§ 280.001–280.003 obligate banks and credit unions to report suspected financial exploitation to APS or law enforcement, with immunity for good-faith reports and authority to delay disbursements.
• Document and preserve. Reporters should preserve all evidence (photographs of injuries, copies of statements, screen captures of communications) without disturbing potential law-enforcement evidence.

14. SOURCES AND REFERENCES

• Tex. Hum. Res. Code Chapter 48 (full text) — https://statutes.capitol.texas.gov/Docs/HR/htm/HR.48.htm
• Tex. Hum. Res. Code § 48.051 — https://statutes.capitol.texas.gov/
• Tex. Hum. Res. Code § 48.052 (Failure to Report) — https://texas.public.law/statutes/tex._human_resources_code_section_48.052
• Tex. Hum. Res. Code § 48.054 (Immunity)
• 40 Tex. Admin. Code Chapter 705 (APS rules) — https://texreg.sos.state.tx.us/
• DFPS Adult Protective Services — https://www.dfps.texas.gov/adult_protection/
• Texas Abuse Hotline — https://www.txabusehotline.org
• DFPS — Who Should Report Abuse — https://www.dfps.texas.gov/Training/APS_Reporting/reporting_who.asp
• HHSC Long-Term Care Regulatory complaints — https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/consumer-rights-services
• Texas Long-Term Care Ombudsman — https://apps.hhs.texas.gov/news_info/ombudsman/
• Tex. Penal Code § 22.04 (Injury to Elderly) — https://statutes.capitol.texas.gov/
• Tex. Penal Code § 32.53 (Exploitation of Child, Elderly, Disabled) — https://statutes.capitol.texas.gov/
• Tex. Finance Code §§ 280.001–280.003 (financial-institution reporting)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Texas mandatory-reporting law requires immediate action; this template is a worksheet, not a substitute for promptly contacting DFPS at 1-800-252-5400 or, in an emergency, 9-1-1. A Texas-licensed attorney must review this template before reliance.