Wyoming Adult Protective Services Report — Vulnerable Adult Abuse, Neglect, Exploitation, Intimidation, or Abandonment

WYOMING ADULT PROTECTIVE SERVICES REPORT

TABLE OF CONTENTS

1. Reporting Channel Selection
2. Reporter Information
3. Vulnerable Adult Information
4. Alleged Perpetrator Information
5. Type of Maltreatment Alleged
6. Narrative of Concerns
7. Witnesses and Corroborating Evidence
8. Risk Assessment and Imminence
9. Prior Reports and Agency Involvement
10. Reporter Certification
11. Wyoming Practice Notes
12. Sources and References

1. REPORTING CHANNEL SELECTION

This written report is submitted to (check all that apply):

• ☐ Wyoming Department of Family Services — Adult Protective Services (statewide hotline 1-800-457-3659)
• ☐ Wyoming DFS local county office — county: [________________________________]
• ☐ Local law enforcement — agency: [________________________________]
• ☐ Wyoming Long-Term Care Ombudsman (1-800-856-4398) — facility-based concerns
• ☐ Wyoming DOH Office of Healthcare Licensing & Surveys (307-777-7123) — licensed facility complaint
• ☐ Wyoming Attorney General — Medicaid Fraud Control Unit — when financial exploitation involves a Medicaid provider
• ☐ Adult Protective Services in another state (multi-state contact): [________________________________]

2. REPORTER INFORMATION

Wyoming permits anonymous reports, but disclosure aids investigation and follow-up. Mandatory reporters in regulated professions should provide identifying information.

3. VULNERABLE ADULT INFORMATION

A "vulnerable adult" under Wyo. Stat. § 35-20-102(a)(xviii) means any person 18 or older who is unable to manage and take care of himself or his money, assets or property without assistance as a result of advanced age or physical or mental disability.

4. ALLEGED PERPETRATOR INFORMATION

5. TYPE OF MALTREATMENT ALLEGED

Check all that apply (statutory definitions in Wyo. Stat. § 35-20-102):

• ☐ Abuse — the intentional or reckless infliction of injury, unreasonable confinement, intimidation, cruel punishment, sexual abuse, or sexual assault
• ☐ Neglect — deprivation of, or failure to provide, the minimum food, shelter, clothing, supervision, physical and mental health care, prescribed therapeutic conduct, or supervision required for the well-being of a vulnerable adult
• ☐ Exploitation — wrongful use of a vulnerable adult or his resources for another's profit, advantage, benefit, or to deprive the vulnerable adult of rightful resources, including unjust enrichment by manipulating, threatening, deceiving, or intimidating
• ☐ Intimidation — communication of a threat with intent to engender fear of physical or emotional harm
• ☐ Abandonment — leaving a vulnerable adult without financial support or means to obtain food, clothing, shelter, or health care
• ☐ Self-neglect — adult's inability, due to physical or mental impairment, to provide essential care or services for himself
• ☐ Sexual abuse / assault
• ☐ Financial exploitation — including theft, fraud, undue influence, deceptive transfers, scams, predatory lending, misuse of POA, suspicious account activity

If financial exploitation is alleged, complete:

6. NARRATIVE OF CONCERNS

Provide a clear, chronological factual account. Distinguish observations from inferences. Use objective language (what was seen, heard, smelled, measured) rather than conclusions.

Description of incident or pattern of concern:

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

Observed physical indicators (bruising, weight loss, pressure ulcers, hygiene, dehydration, soiled clothing, unsafe living conditions, malnourishment, untreated medical issues):

[____________________________________________________________]

Observed behavioral indicators (fear of caregiver, withdrawal, agitation, sudden personality change, depression, suicidal statements):

[____________________________________________________________]

Observed financial indicators (unpaid bills despite resources, unusual withdrawals, missing belongings, new "friend" with sudden access, isolating behavior by caregiver, sudden estate-planning changes):

[____________________________________________________________]

7. WITNESSES AND CORROBORATING EVIDENCE

Documentation enclosed or available:

• ☐ Photographs of injuries / conditions (date-stamped)
• ☐ Medical records / treatment notes
• ☐ Bank statements / financial records
• ☐ Powers of attorney / guardianship orders / trust documents
• ☐ Recorded voicemails / texts / emails
• ☐ Prior incident reports
• ☐ Facility care plans / nursing notes (if facility-based)
• ☐ Police / EMS / 911 reports
• ☐ Other: [________________________________]

8. RISK ASSESSMENT AND IMMINENCE

If imminent danger is checked, the reporter has also placed (or should now place) a 911 call. This written form does NOT substitute for emergency response.

9. PRIOR REPORTS AND AGENCY INVOLVEMENT

10. REPORTER CERTIFICATION

I certify that the foregoing is true and accurate to the best of my knowledge and belief. I make this report in good faith pursuant to Wyo. Stat. § 35-20-103. I understand that I am entitled to the immunity provided by Wyo. Stat. § 35-20-114 for good-faith reports and good-faith participation in any investigation arising from this report. I further understand that knowingly false or factually baseless reports are NOT protected and may expose me to civil and criminal liability.

[________________________________]    Date: [__/__/____]

[REPORTER — print and sign]

11. WYOMING PRACTICE NOTES

• Universal mandatory reporting. Wyo. Stat. § 35-20-103 imposes a duty on "any person or agency." Reporting is not limited to enumerated professionals.
• Immediate reporting. The statute requires "immediate" reporting. Calling the DFS APS hotline (1-800-457-3659) or local law enforcement satisfies the oral component; this template documents the written follow-up.
• 24-hour availability. DFS maintains an on-call caseworker after hours. For imminent danger, dial 911.
• Confidentiality. APS records are confidential under Wyo. Stat. § 35-20-112 and may be released only as authorized. Reporters' identities are protected to the maximum extent permitted by law.
• Central registry. Substantiated reports are entered into the central registry under Wyo. Stat. § 35-20-115.
• Criminal referral. Conduct may also violate Wyo. Stat. § 6-2-507 (criminal abuse, neglect, exploitation, or intimidation of a vulnerable adult), which is felony-graded depending on injury and intent. APS investigators routinely coordinate with the county sheriff or prosecuting attorney for criminal referrals.
• Financial exploitation — mandatory bank reporting. Wyoming financial institutions have specific authorities under Wyo. Stat. § 13-3-403 (Financial Exploitation of Vulnerable Adults — bank/credit-union holds and reporting). Encourage banks to file SAR-EFE reports with FinCEN where applicable.
• Long-term-care facility nexus. When the suspected maltreatment occurred in a licensed facility (nursing home, assisted living, adult family-care home), parallel-report to the Wyoming Long-Term Care Ombudsman (1-800-856-4398) AND the WDH Office of Healthcare Licensing & Surveys (307-777-7123).
• Tribal jurisdiction. Reports involving Wind River Indian Reservation residents may require coordination with the Eastern Shoshone or Northern Arapaho Social Services and BIA / federal authorities; do not delay state reporting.
• Failure-to-report exposure. Caretakers who fail to obtain or provide care may face criminal exposure under Wyo. Stat. § 6-2-507 in addition to APS regulatory exposure.

12. SOURCES AND REFERENCES

• Wyoming DFS — Reporting Abuse / Neglect / Exploitation — https://dfs.wyo.gov/i-need-to-report/abuse-neglect-exploitation/
• Wyoming DFS — Adult Protection Services — https://dfs.wyo.gov/services/elderly-and-disabled/adult-protection-services/
• Wyoming Statutes Title 35, Chapter 20 (Adult Protective Services) — https://law.justia.com/codes/wyoming/title-35/chapter-20/
• Wyo. Stat. § 35-20-103 — https://codes.findlaw.com/wy/title-35-public-health-and-safety/wy-st-sect-35-20-103/
• Wyo. Stat. § 35-20-114 (Immunity) — https://law.justia.com/codes/wyoming/2015/title-35/chapter-20/section-35-20-114/
• Wyo. Stat. § 6-2-507 (Criminal abuse / neglect / exploitation of vulnerable adult)
• Wyoming Long-Term Care Ombudsman — https://health.wyo.gov/admin/long-term-care-ombudsman-program/
• Wyoming Senior Citizens, Inc. (Ombudsman Program) — https://www.wyomingseniors.com/services/long-term-care-ombudsman
• WDH Healthcare Licensing & Surveys — Complaints — https://health.wyo.gov/aging/hls/complaints-against-healthcare-facilities/
• LSO Memorandum on Financial Exploitation — https://wyoleg.gov/InterimCommittee/2022/01-2022091216-01Judiciary-FinancialExploitationMemo.pdf
• National Adult Protective Services Association (NAPSA) — https://www.napsa-now.org/

Disclaimer: This template is informational and does not constitute legal advice. Wyoming law mandates immediate reporting of suspected abuse, neglect, or exploitation of a vulnerable adult. Use of this written form is supplemental to, and never a substitute for, immediate oral notification to law enforcement or DFS where circumstances warrant.