The reports required under this subchapter must contain all of the following information: (1) The name and sex of the patient or resident. (2) The name and address of the facility in which the patient or resident resides. (3) The age of the patient or resident, if known. (4) The name and address of the reporter and where the reporter can be contacted. (5) Any information relative to the nature and extent of the abuse, neglect, mistreatment, financial exploitation, or medication diversion and, if known to the reporter, any information relative to prior abuse, neglect, mistreatment, financial exploitation, or medication diversion of the patient or resident. (6) The circumstances under which the reporter became aware of the abuse, neglect, mistreatment, financial exploitation, or medication diversion. (7) What action, if any, was taken to treat or otherwise assist the patient or resident. (8) Any other information which the reporter believes to be relevant in establishing the cause of the abuse, neglect, mistreatment, financial exploitation, or medication diversion.
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