Protective Services Report







In this section, you will fill out your contact information so that we can contact
            you if we need additional information.  We must have at least your name and a phone
            number to ensure that we can properly address your concern in case additional information is needed.  Per RI General Law 42-66-10, protective service records of OHA are deemed confidential.  Therefore, OHA is unable to provide information back to reporters or other callers on the status and/or outcome of any cases reported to ERS. In this section, you will fill out your contact information so that we can contact you if we need additional information. We must have at least your name and a phone number to ensure that we can properly address your concern in case additional information is needed. Per RI General Law 42-66-10, protective service records of OHA are deemed confidential. Therefore, OHA is unable to provide information back to reporters or other callers on the status and/or outcome of any cases reported to ERS.
Date of Birth



In this section, you will describe what caused you to fill out a report on the client.  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, you will describe what caused you to fill out a report on the client. 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.
What date did the incident occur?
:

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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