MA Adult Protective Services Report







If this report is an emergency or requires immediate attention, DO NOT file an online report.  Additionally, if you do not have the full address where the elder resides you will not be able to file an online report.  In such instances please make a verbal report to the Massachusetts Elder Abuse Hotline at 1-800-922-2275.  When filing an online report it is important to provide as much detail as possible and complete all required fields.  If you include your email address you will receive an email confirmation for your records after the report is submitted. If this report is an emergency or requires immediate attention, DO NOT file an online report. Additionally, if you do not have the full address where the elder resides you will not be able to file an online report. In such instances please make a verbal report to the Massachusetts Elder Abuse Hotline at 1-800-922-2275. When filing an online report it is important to provide as much detail as possible and complete all required fields. If you include your email address you will receive an email confirmation for your records after the report is submitted.

In this section, please describe what caused you to fill out a report on the involved
            person.  If anyone saw the incident happen, you will need to add their contact information
            to the Other Participant Section.  Please answer as many of the following questions as you can. In this section, please describe what caused you to fill out a report on the involved person. If anyone saw the incident happen, you will need to add their contact information to the Other Participant Section. Please answer as many of the following questions as you can.
Incident date required
Screening Code required
Is this a Self-Neglect report? required

Please describe the incident in details and include the following information. Please describe the incident in details and include the following information.















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