Abuse Reporting Responsibilities
Child Abuse Reporting: I, ___________________________________,
hereby attest that I understand my obligation to report instances of child
abuse as required by penal code Section 11165-11174 and will fulfill this
obligation.
Section 11165-11174 of the Penal Code requires any child care custodian,
medical practitioner, or non-medical practitioner, or employee of a child
protective agency who has knowledge of or observes a child in his or her
professional capacity or within the scope of his or her employment whom
he or she knows or reasonably suspects has been the victim of child abuse
to report the known or suspected instance of child abuse to a child
protective agency (the San Francisco Sheriff's Department, the San
Francisco Police Department, the County Welfare Department or my local
equivalent) immediately, or as soon as practically possible by telephone,
and to prepare and send a written report thereof within 36 hours of
receiving the information concerning the incident. Consensual sex with a
minor is reportable as child abuse under the following circumstances: 1)
Sexual intercourse when the minor is under fourteen and the perpetrator is
over fourteen, or 2) lewd and lascivious acts when the minor is fourteen or
fifteen and the perpetrator is more than ten years older than the victim.
Elder and Dependent Adult Abuse Reporting: I understand that I am also
required to report instances of "elder and Dependent Adult Abuse" to the
Adult Protective Services, the San Francisco Sheriff's Department or
Police Department, or Family Service Agency of San Francisco, County
Welfare Department or my local equivalent.
"Elder" means any person residing in this state aged 65 or older. A
"dependent adult" is any person residing in this state, aged 18-64, who has
physical or mental limitations that restrict his or her ability to carry out
normal activities or to protect his or her rights including, but not limited to,
persons who have physical or developmental inabilities or whose physical
or mental abilities have diminished because of age. Anyone aged 18-64
admitted as an inpatient in a 24-hour facility may be considered a
dependent adult.
Physical abuse includes assault, battery, unreasonable physical restraint,
prolonged or continued deprivation of food or water, or sexual assault.
I must report any incident that reasonably appears to be physical abuse; or
if I have observed a physical injury when the nature of that injury, its
location on the body, or the repetitions of the injury clearly indicates that
physical abuse has occurred; or am told by an elder or dependent adult
that she or he has experienced behavior constituting physical abuse.
mandated reporters may report other types of abuse when they have
knowledge of or reasonably suspect such abuse. mandated reporters may
also report suspicion that the abused adult's well being is endangered in
any way. The reporter is required to give her or his name. The reporter is
immune from civil or criminal liability for the report.
Mandated Reporters of Child Abuse and Elder Abuse
"Child care custodian" includes teachers, administrative officers,
supervisors of child welfare and attendance, or certified pupil personnel
employees of any public or private school; administrators of a private or
public day camp; licensed day care workers; administrators of community
care facilities licensed to care for children; Headstart teachers, licensing
workers or evaluators; public assistance workers; employees of child care
institution, including, but not limited to foster parents, group home
personnel, and personnel of residential care facilities; and social workers
or probation officers.
"Medical practitioner" includes physicians and surgeons, psychiatrists,
psychologists, dentists, residents, interns, podiatrists, chiropractors,
licensed nurses, dental hygienists, or any other person who is licensed
under Division 2 (commencing with Section 500) of the Business and
professions Code.
"Non-medical practitioner" includes state or county public health
employees who treat minors for venereal disease or any other condition;
coroners; paramedics; marriage, family or child counselors; and religious
practitioners who diagnose, examine or treat children.
Domestic Violence Reporting: I further understand that if I am a health
practitioner as defined in this paragraph, providing medical services for a
physical condition to a patient, I must comply with Section 1257.7 of the
Health and Safety Code, and amended Section 11160 of the Penal Code
relating to health, and report suspected domestic violence as described in
this document and the domestic violence policy of the Haight Ashbury Free
Clinics, Inc. Health practitioners (including physicians, surgeons,
psychiatrists, psychologists, dentists, residents, interns, podiatrists,
chiropractors, licensed nurses, dental hygienists, optometrists, MFTs, MFT
trainees or registered interns, emergency medical technicians I or II,
paramedics, public health employees who treat minors, coroners, persons
who perform autopsies and religious practitioners who diagnose, examine
or treat children) employed in a health facility; clinic; physician's office;
local or state public health department; or public health department
operated clinic or facility are required to make a report if she or he provides
medical services for a physical condition to a patient whom she or he
knows or reasonably suspects is suffering form any wound or other
physical injury due to a firearm and/or assaultive or abusive conduct.
Assaultive or abusive conduct includes murder, manslaughter, torture,
battery, sexual battery, incest, assault with a deadly weapon, rape, spousal
rape, and abuse of spouse or cohabitant. The health practitioner is
required to make a report by telephone immediately or as soon as
practically possible and send a written report to a local law enforcement
agency within two working days.