DDS PA-6 Form
Overview and Direction
The DDS PA-6 Form, Report of Suspected Abuse or Neglect of an Adult with Intellectual Disability is to be filled out and sent to DDS at(firstname.lastname@example.org ) by mandatory reporters as a follow-up to an oral report being made to the Abuse Investigation Division (AID), which can be reached by dialing 1-844-878-8923 (toll free). The form should not be sent to AID unless an oral report has first been made to AID consistent with C.G.S. § 46a – 11b. A completed PA 6 should include the name, date of birth and address and telephone number of the alleged victim of abuse or neglect. The form should also include the reasons the reporter believes the victim to have an intellectual disability, information supporting the victim’s inability to protect themselves from abuse or neglect and importantly, information regarding the extent of the suspected abuse or neglect and any supporting information. Lastly, the name and address of the person reporting should be included as well as a number where they can be reached.
Note: Mandatory reporters who work in the DDS provider system should ensure that a 255 Unusual Incident Report has been completed and submitted describing the incident that they are reporting to AID and also ensure that the incident report is checked off in the appropriate box as being a situation that caused suspected abuse or neglect.
A 255 Incident Report completed in this way by a reporter does not have to also be followed up with a DDS PA 6 form unless the reporter wishes to remain anonymous, in which case a PA 6 form should also be completed and forwarded to AID.