Long-term Care Nursing Assistant Program
Abuse Reporting Forms

Immediate Fax Reporting of Allegation(s)
This form must be completed in its entirety and submitted to this office within 24 hours of time of incident to report any allegation(s) of abuse, neglect or misappropriation of resident property by a Registered Long-Term Care Nursing Assistant
Five Day Follow Up Report of Allegation(s)
This form must be completed in its entirety and submitted to this office within 5 days of the date immediate reported to report outcome of facility investigation for allegation of abuse, neglect or misappropriation of resident property by a Registered Long-Term Care Nursing Assistant
Fax Request for Extension - Five Day Follow-up
This form must be completed in its entirety and submitted to this office within 5 days of the date the immediate reported to request an extension for the facility to continue investigation for allegation of abuse, neglect or misappropriation of resident property by a Registered Long-Term Care Nursing Assistant.
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