How to Complete the Pennsylvania Act 13 Mandatory Abuse Report Form

To file Pennsylvania’s Act 13 mandatory abuse report, call the statewide Elder Abuse Helpline at 1-800-490-8505 the moment you suspect abuse, notify your facility administrator, and submit the completed written form (PDA/DHS MAR) to your local Area Agency on Aging within 48 hours.¹² The written form is a two-page PDF, and the clock starts the moment suspicion forms, not after any internal review.

Where to Get the Form

The Act 13 Mandatory Abuse Report Form (form number PDA/DHS MAR) is a downloadable PDF on the Pennsylvania Department of Human Services website.³ Most licensed facilities keep blank copies in their administrative offices. If yours doesn’t, raise it with your administrator. The form has to be accessible to every staff member at all times, because the 48-hour deadline doesn’t pause while you hunt for a copy.

What to Put on the Form

The form captures what an investigator needs to open a case. Stick to facts throughout. Describe what you saw, heard, or were told, and leave conclusions to the investigator.

Reporter Information

Enter your full name, job title, phone number, email address, and your signature with the date.³ This establishes you as the reporting party and gives investigators a way to reach you with follow-up questions. The confidentiality rules discussed further down protect this information from being disclosed outside the investigation.

Victim Information

Provide the resident’s full name (last, first, middle initial), date of birth, and sex. The form also asks you to identify the facility type using abbreviations such as NH (nursing home), PCH (personal care home), DC (domiciliary care), or CLA (community living arrangement).³ It does not ask for the resident’s Social Security number.

Facility Information

Record the facility’s name, full street address, city, state, and ZIP code. You also need the licensing agency’s name and the facility’s license number. Both should be posted inside the facility or available from the administrator.³

Incident Narrative

This is the heart of the report. The statute requires it to include, at minimum, the nature of the alleged offense and any specific observations directly related to the incident and the people involved.⁴ In practice, include:

The date, time, and specific location within the facility where the incident occurred or was discovered.
A factual description of what happened: visible injuries, behavioral changes, statements the resident made.
The name and role of the alleged perpetrator, if known.
The names of any witnesses.
Whether medical treatment was sought, and if so, the name of the treating provider.
The resident’s current cognitive status and ability to communicate about the event.

Write in plain, descriptive language. “Resident had a four-inch bruise on the left forearm and stated that staff member John Smith grabbed her arm during a transfer” is far more useful than “possible abuse observed.” Skip conclusions like “I believe this was intentional.” Describe what you observed and let the evidence stand on its own.

How to File It

Every Act 13 report is a two-step process: an immediate oral report, then the written form within 48 hours. The exact path depends on what kind of abuse you suspect.

Standard Reports

For most cases of suspected abuse, follow these steps in order:¹

Call the Elder Abuse Helpline at 1-800-490-8505 (staffed 24/7) immediately to make the oral report to your local Area Agency on Aging.²
Immediately notify the facility administrator or their designee.
Submit the completed written form to the local Area Agency on Aging within 48 hours of the initial suspicion. You may ask the administrator to help you prepare the written report.

Elevated Reports: Sexual Abuse, Serious Injury, or Suspicious Death

When the suspected abuse involves sexual abuse, serious physical injury, serious bodily injury, or a suspicious death, additional steps are required on top of the standard process:⁵

Contact local law enforcement immediately to make an oral report.
Call the Mandatory Abuse Reporting Line at 717-265-7887, option 2, to notify the Department of Aging.
Submit a joint written report, prepared together with the facility administrator, to both law enforcement and the local Area Agency on Aging within 48 hours.

Deadlines and Who Uses This Form

The oral report is immediate. The written form is due within 48 hours of the first suspicion of abuse, not 48 hours from when the administrator confirms it or an internal review concludes.¹

Any employee or administrator of a covered facility who has reasonable cause to suspect abuse of a care-dependent resident is legally required to report it.⁶ You don’t need to witness anything firsthand or confirm that abuse happened. “Reasonable cause to suspect” is a deliberately low bar. If something looks wrong, you report it.

Covered facilities under the statute are long-term care nursing facilities, personal care homes, domiciliary care homes, home health care agencies, and older adult daily living centers.⁷⁵

You don’t need to decide which statutory category your suspicion fits. The reportable categories are physical abuse, sexual abuse, neglect, abandonment, exploitation, and suspicious death.⁶ Classification is the investigator’s job.

What Protects You When You Report

Pennsylvania law gives reporters three protections: immunity, confidentiality, and protection against workplace retaliation.

Anyone who makes a report or testifies in a proceeding arising from a report is immune from civil and criminal liability as long as they acted in good faith. The immunity does not shield someone who committed the abuse itself, even if that person also filed the report.⁸

Reports filed under Chapter 7 are confidential by default. The statute prohibits releasing information that would identify the person who made the report, except to law enforcement officials investigating the case. Even when other parties, such as medical providers or the resident’s guardian, are allowed access to report records, the reporter’s identity stays protected.⁷

Employers cannot discharge, refuse to hire, or retaliate against an employee for filing a mandatory abuse report. If you experience retaliation after filing, you have legal recourse under the statute.

What Happens If You Don’t Report

A person required to report who willfully fails to do so commits a summary offense for the first violation. A second or subsequent failure is a third-degree misdemeanor.⁹ A summary offense in Pennsylvania can carry a fine of up to $300 and up to 90 days in jail. A third-degree misdemeanor carries a potential fine of up to $2,500 and up to one year of imprisonment.

The operative word is “willfully.” An honest misjudgment about whether something rose to the level of reportable abuse is different from deliberately looking the other way. The safest course is always to report. The immunity provisions cover good-faith reporters, and the penalties target only those who knowingly stay silent.

1
Commonwealth of Pennsylvania. Pennsylvania Code Chapter 15 – Protective Services for Older Adults General Provisions
2
Department of Aging. Report Suspected Abuse of an Older Adult
3
Pennsylvania Department of Human Services. Pennsylvania Act 13 Mandatory Abuse Report Form
4
Pennsylvania General Assembly. Pennsylvania Code 35 P.S. 10225.701 – Reporting by Employees
5
Pennsylvania Coalition Against Rape. Older Adult Protective Services Act Mandatory Reporting and Confidentiality Requirements
6
Pennsylvania General Assembly. Pennsylvania Code – Older Adults Protective Services Act
7
Commonwealth of Pennsylvania. Pennsylvania Code 35 P.S. 10225.101 et seq – Older Adults Protective Services Act
8
Pennsylvania General Assembly. Pennsylvania Code 35 P.S. 10225.302 – Immunity
9
Pennsylvania General Assembly. Pennsylvania Code 35 P.S. 10225.706 – Penalties for Failure to Report