APS Forms Quick Reference
| Form | Cite & APS System | Purpose of Form/Section | Timeframes |
|---|---|---|---|
| APS-1-AM (08AP101E) ** | (340:5-5-5-1a) (LOGS) | Tracks all reports by month for each county/APS specialist. Good management tool | Completed upon receipt of the referral, then submitted to the state office by the 10th of the month for the preceding month. |
| APS-1 (O8AP001E) ** | (340:5-3-1(b)) APS- New Intake Report | Record initial reports | Completed at intake and routed immediately to the APSS IV for screening and assignment. |
| APS-10 (O8AP010E) ** | APS-Risk Assessment Tab | Used to analyze client’s situation to determine risks of abuse, neglect and exploitation (Maltreatment). Establishes baseline data from which future assessments will be measured. Scoring is automatic on the APS system. New APS specialists need to use the paper APS-10 form and perform the calculations as a learning tool. | Completed based on initial face-to-face with client. Also completed on cases requiring follow up. |
| APS-11 (08AP011E) ** | APS = Needs Assessment Tab | Records completed assessment of client’s functioning based on physical health, mental health, social, financial, and environmental factors | Completed based on initial face-to-face with client. |
| APS-2 (08AP002E) ** | ( 340:5-5-5-1(h)) | The summary of the investigation, used as a reporting form to the Office of the District Attorney and the State Office. The form has several parts which the APS specialist can use to report collateral contacts, the service plan, and the nurse’s assessment, if any. | Completed at the conclusion of the investigation. |
| APS-2 A (08AP003E) | (340:5-5-6 instructions to staff 3(c) | Nursing Assessment | |
| APS-2 D (08AP005E) | Interview Tab | Documents contacts after the referral is received. | Completed at the time of the contact with the client or collateral. |
| APS-2-E (08APOO6E) | Service Plan tab | Documents the service plan | Completed based on initial face-to-face with client. |
| ASP-15 (08AP015E) | 340:5-5-4 | Transmittal to Client Advocacy | 3 working days |
| APS-17 (08AP017E) | 340:5-5-6 Instructions to staff 2 Emergency Request Tab | Emergency Request Form | |
| Notes, Comments, & Interviews | NOTES, COMMENTS, are interspersed throughout the APS System. INTERVIEWS are documented on the Interview Tab. | Completed at the time of the contact with the client or collateral. | |
| Notifications 340:5-5-3 (1) | The law requires that the Department notify specific persons of receipt if a referral and completion of the investigation. This is done by using the Q&A Pamphlet at the initial contact, and by mailing a form letter at completion of the investigation. Examples are included in the appendix for your information. | ||
| Completing the investigation | Policy requires that the investigation be completed within 30 or 60 days depending upon the type of investigation. 30 days for Self Neglect and 60 days when there is an alleged perpetrator. 340:5-5-3-(9) |