Mississippi Vulnerable Adult Protective Services (APS) Report - A Vulnerable Person is person whose ability to perform the normal activities of daily living, or to provide for his or her own care, protection from abuse, neglect, exploitation or improper sexual conduct, is IMPAIRED due to mental, emotional, physical, or developmental disability or dysfunction, brain damage, or the infirmities of aging. APS investigates abuse incidents of vulnerable persons age 18 or older who reside in private home settings. Visit www.mdhs.ms.gov for more details. If this is a life-threatening emergency, call 911.
Reporter Information
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Mandated Reporter
Criminal Justice Employee
Accountant
Attorney
Credit Union Officer/Employee
Financial Advisor/Consultant
Family Protection Worker
Family Protection Specialist
Bank Officer/Employee
Chiropractor
Financial Planner
Health Professional
Human Rights Advocate
Institutional Staff
Insurance Agent
Investment Advisor/Consultant
Law Enforcement Officer
Long-term Care Ombudsman
Medical Examiner
Mental Health Practitioner
Nurse
Physician
Savings and Loan Officer
Social Worker
Spiritual Practitioner
Stockbroker
Agency
Job Title
First Name
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Last Name
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Middle Initial
Address Type
Home
School
Temporary
Vacation
Work
Unknown
Other
Mailing
Reporter Street Address
Apartment/PO Box Number
City
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State
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Zip Code
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County
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Contact Phone Number
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Ext.
Phone Type
Home1
Home2
Fax
Message
Cell
Pager
Work
Unknown
Other
Modem
TTY/TDD
Voice
Voice/Fax
Voice/TTY/TDD
Secondary Phone Number
Ext.
Phone Type
Home1
Home2
Fax
Message
Cell
Pager
Work
Unknown
Other
Modem
TTY/TDD
Voice
Voice/Fax
Voice/TTY/TDD
Email Address
Relationship to Alleged Victim
Domestic Partner, including civil union
Grandchild
Parent
Self
Sibling
Spouse
Other Relative
None
Grandparent
Child
Relationship to Incident
Alleged Perpetrator
Alleged Victim
Biological Child
Collateral Contact
Financial Institution
Household Member
Law Enforcement
Non-Relative
Other
Other Professional
Power of Attorney
Primary Caretaker
Reference Person
Service Provider
Spouse
Staff
Unknown
Witness
Best Time to Contact
Incident Information
Help
Incident Date
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Incident Time
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Incident Location
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Alleged Victim Home
Community Care/Day Care Facility
Community Program
Correctional Institution
Home Based Care
Home of Other
Homeless Shelter
Hospital
Licensed Assisted Living
Non Relative Home
Nursing Facility
Other
Rehabilitation Facility
State Institution
Unknown
Unlicensed Assisted Living
Did the Incident occur at an Agency or Facility?
Yes
No
Agency/Facility Name
Agency/Facility Phone Number
Incident Street Address
Apartment/PO Box Number
City
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State
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Zip Code
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County
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Has Law Enforcement been involved?
Previously Notified
Notification - Not Necessary
Notification - Emergency
Notification - Non-Emergency
Unknown
Incident Description:
Risk to Social Worker?
Yes
No
Unknown
If Yes, please explain.
Alleged Victim Information
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Alleged Perpetrator Information
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Allegations
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