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Prevention and Protection Services

PPM 10000 Adult Protective Services Forms

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Listing of key staff
Form NumberForm DateForm Name Form Instructions Other Languages
PPS 10000
07/2026
​Kansas Adult Protective Services
Brochure
doc
pdf​

 


​PPS 10001​04/2026
​Understanding Your Role as Power of Attorneypdfspapdf​
​PPS 10050​04/2026
​Financial Exploitation ​doc  pdf
PPS 1010004/2026
Adult Protective Services Intake doc  pdf   
PPS 1011004/2026
Adult Protective Service Screening Report doc  pdf   
​PPS 10120 A​04/2026
​Potential Criminal Notification Coversheetdoc  pdf
PPS 10125​​04/2026
​Notification to KDADS ​doc  pdf
​PPS 10130

​04/2026

​Notice of Action to Reporters for Adult Abuse Reports ​doc  pdf
​PPS 1020004/2026
​Adult Protective Services Case Activity Log ​doc  pdf
​PPS 10204A​04/2026
Notice of Allegation Change​doc  pdf
​PPS 10205​07/2026
​Your Rights During an Adult Protective Services Assessment for Self-neglect ​doc  pdf spapdf​
PPS 10208​​07/2026
Your Rights during an APS Investigation Brochure​doc
pdf
​spapdf
​PPS 10209​04/2026
​Bank Release of Recordsdoc  pdf
PPS 10210​​04/2026
​Authorization for Release of Confidential Informationdoc  pdf
​PPS 10211​04/2026
​Release of Records Relevant to Adult Protective Services Investigationdoc  pdf
PPS 10212​​04/2026
APS Critical/Significant Incident Report​ ​doc  pdf
​PPS 10215​04/2026
​Non-Critical Death Notification ​doc  pdf
​PPS 10224A​01/2024​ Cornell-Penn Interview for Decisional Abilities (IDA) Kansas Edition - 3.0​     pdf
​PPS 10224B01/2025​​Cornell-Penn Interview for Decisional Abilities (IDA) Kansas Edition - 3.0 (28 pt. font)​       pdf
​PPS 10224C01/2025​Cornell-Penn Interview for Decisional Abilities (IDA) Kansas Shortform​       pdf
​PPS 10224D​01/2025​Cornell-Penn Interview for Decisional Abilities (IDA) Kansas Shortform (28 pt. font)​       pdf
PPS 10230​04/2026
​Interview Notice to Alleged Perpetratordoc  pdf spadoc spapdf
​PPS 10231​04/2026
​Involved Adult Interview Request Letter ​docpdf​
​PPS 1024004/2026
​What you need to know about Investigations of Adult Abuse, Neglect, Exploitation, or Fiduciary Abusepdf ​  ​spapdf
​PPS 10250​04/2026
​Corrective Action Plan ​doc​  pdf​ doc  pdf​​
​PPS 10300​04/2026
​Notice of Agency Decision ​doc  pdf spadoc spapdf
​PPS 10310​04/2026
​Notification to Regional Adult Abuse/Neglect Registry Contactdoc  pdf
PPS 10315​​04/2026
​Notice of Termination of Corrective Action Plandoc  pdf
PPS 10320​A​04/2026
​Notice of APS Case Closure- For Self Neglect Casesdoc  pdf spadocspapdf
​PPS 10320B​04/2026​Notice of APS Case Closure - Non Self Neglect Cases ​doc  pdf
​PPS 10322A​04/2026
​APS Confirmation Finding for Crisis Excepetion Requestsdoc  pdf​
​PPS 10330​04/2026
​Appeal Summary ​doc  pdf
​PPS 10340​04/2026
​Notification to Facility Regarding APS Finding ​doc  pdf
​PPS 10350​04/2026
​Substantiation Notification to Law Enforcement ​doc  pdf
​PPS 1036004/2026
​Report to State Regulatory Authority from APS Regarding Finding of Abuse, Neglect, or Exploitationdoc  pdf ​ 
PPS 10370​​04/2026
ANE Unit Cover Sheet​doc  pdf
​ PPS 10500​04/2026​Adult Protective Service Plan ​doc​  pdf
​ PPS 10510
​04/2026​Emergency APS Admissions to Nursing Facilitiesdoc  pdf
​PPS 10600A​07/2026
​Adult Guardianship / Conservatorship Referral/Notificationdoc
pdf​
​PPS 10600B
07/2026
​Youth Guardianship / Conservatorship Referral
doc  pdf
​PPS 10610​04/2026
​Decision-Making and Functional Assessment: Criteria for Legal Impairment a Multi-disciplinary Tooldoc  pdf

 

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