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Address No. Street 15c. City 16d. State 16e. Zip Code 16f. Phone No. 45 Private Agency Social Worker 46 Court Social Worker 47 Other Social Worker 48 FIS/ES Worker/Supervisor 49 Social Services Specialist/Manager CPS FC etc. 52 DHS Facility Personnel 55 Private Social Agency Personnel 56 Court Personnel DHS-3200 Rev. 2-12 Previous edition may be used. MS Word TO BE COMPLETED BY MEDICAL PERSONNEL WHEN PHYSICAL EXAMINATION HAS BEEN DONE 20. REPORT OF ACTUAL OR SUSPECTED CHILD ABUSE OR NEGLECT...
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Report of Actual or Suspected Child Abuse or ... - State of Michigan
15.-19 - Reporting person's name - Enter the name and address of person(s) reporting this matter. DHS-3200 (Rev. 10-15) Previous edition may be used. 1.
Michigan Legislature - Section 722.623
722.623 Individual required to report child abuse or neglect; written report; contents ... or 520b to 520g of the Michigan penal code, 1931 PA 328, MCL 750.136b, ...
Michigan Legislature - Section 722.628
722.628 Referring report or commencing investigation; informing parent or legal guardian of ... (a) Abuse or neglect is the suspected cause of a child's death.
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MI DHS-3200 Form Versions

Version Form Popularity Fillable & printable
MI DHS-3200 2012 4.9 Satisfied
(56 Votes)
MI DHS-3200 2008-11 4.1 Satisfied
(26 Votes)
MI DHS-3200 2008-02 4.0 Satisfied
(29 Votes)
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