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  • DHS-3200, Report of Actual or Suspected Child Abuse or Neglect - FCNP
    DHS-3200 (Rev 10-12) Previous edition may be used MS Word 2 TO BE COMPLETED BY MEDICAL PERSONNEL WHEN PHYSICAL EXAMINATION HAS BEEN DONE 20 Summary report and conclusions of physical examination (Attach Medical Documentation) 21 Laboratory report 22 X-Ray 23 Other (specify) 24 History or physical signs of previous abuse neglect YES NO 25
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  • DHS-3200, REPORT OF ACTUAL OR SUSPECTED CHILD ABUSE OR NEGLECT
    INSTRUCTIONS: REPORTING PERSON: Complete items 1-12 (13-25 should be completed by medical personnel, if applicable) Send to Centralized Intake via a method listed on page 2
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