Adult Protective Services – NCDHHS Policies and Manuals

NC Department of Health & Human Services

NCDHHS Policies and Manuals > Divisional A-M > Aging and Adult Services > Adult Protective Services

Adult Protective Services

Title	Type	Format	Size
Adult Protective Services Manual	Manual	pdf	1 MB	Open Preview
Adult Protective Services Register (APS-R ) User’s Manual	Manual	pdf	291 KB	Open Preview
APS Monitoring Tool	Form	xls	786 KB	Open
APS Monitoring Tool Instructions	Form	pdf	236 KB	Open Preview

Title	Type	Format	Size
Affidavit for Administrative Search and Inspection Warrant- AOC-CR-913M	Form	pdf		Open
Certificate of Service (Adult Protective Services)- AOC-CV-771	Form	pdf		Open
Certification to Financial Institution as required by G.S. 53B-5- AOC-CV-779	Form	pdf		Open
Notice of Hearing in Emergency Protective Services Proceedings- AOC-CV-774	Form	pdf		Open
Notice of Hearing Protective Services Proceedings- AOC-CV-772	Form	pdf		Open
Notice of Hearing to Enjoin with Protective Services (Consenting disabled Adult)- AOC-CV-781	Form	pdf		Open
Notice of Order to Authorize Inspection of Financial Records and to Freeze Assets- AOC-CV-778	Form	pdf		Open
Order Authorizing Emergency Services/Ex Parte Emergency Services- AOC-CV-775	Form	pdf		Open
Order Authorizing Protective Services- AOC-CV-773	Form	pdf		Open
Order to Authorize Inspection of Financial Records and to Freeze Assets- AOC-CV-777	Form	pdf		Open
Order to Enjoin Interference with Protective Services (Consenting Disabled Adult)- AOC-CV-782	Form	pdf		Open
Petition and Order for Issuance of Subpoena Directing Release of Financial Records- AOC-SP-630	Form	pdf		Open
Petition for Order Authorizing Protective Services/Emergency Services/Ex Parte Emergency Services and Appointment of Guardian Ad Litem- AOC-CV-770	Form	pdf		Open
Petition for Order to Inspect Financial Records and to Freeze Assets- AOC-CV-776	Form	pdf		Open
Petition to Enjoin Interference with Protective Services- AOC-CV-780	Form	pdf		Open

Title	Type	Format	Size
DAAS-0001 Adult Protective Services Intake	Form	docx	73 KB	Open
DAAS-0002 Notice to Reporter: Initial Notice	Form	docx	29 KB	Open
DAAS-0003 Notice to Administrator: Completion of Evaluation	Form	docx	31 KB	Open
DAAS-0004 Notice to Reporter: Completion of Evaluation	Form	docx	28 KB	Open
DAAS-0005 Community Evaluation	Form	docx	123 KB	Open
DAAS-0006 Facility Evaluation	Form	docx	132 KB	Open
DAAS-0007 Diligent Efforts to Locate Adult	Form	docx	39 KB	Open
DAAS-0008 Notice to the District Attorney and/or Law Enforcement: Initial Notice	Form	docx	34 KB	Open
DAAS-0009 The Written Report of Adult Protective Services Evaluation	Form	docx	47 KB	Open
DAAS-0010 Notice to Financial Customer	Form	docx	32 KB	Open
DAAS-0011 Service Plan	Form	docx	47 KB	Open
DAAS-0013 Determination of Ability to Consent to Protective Services	Form	docx	32 KB	Open
DAAS-0014 Notice of Request for Records for Adult Protective Services Evaluation	Form	docx	24 KB	Open
DAAS-5026 Report to Adult Protective Services Register	Form	xlsx	78 KB	Open
DAAS-5337-A Request for Patient Information for Veteran	Form	docx	903 KB	Open

Title	Type	Format	Size
DAAS-0001 Adult Protective Services Intake	Form	docx	60 KB	Open
DAAS-0005 Community Evaluation	Form	docx	93 KB	Open
DAAS-0006 Facility Evaluation	Form	docx	96 KB	Open
DAAS-0007 Diligent Efforts to Locate Adult	Form	docx	28 KB	Open
DAAS-0009 The Written Report of Adult Protective Services Evaluation	Form	docx	34 KB	Open
DAAS-0011 Service Plan	Form	docx	40 KB	Open
DAAS-0013 Determination of Ability to Consent to Protective Services	Form	docx	31 KB	Open
DAAS-0015 Consent for Financial Records	Form	docx	36 KB	Open
DAAS-0016 Consent for Release of Information	Form	docx	32 KB	Open