REPORT OF SUSPECTED CHILD ABUSE (CHILD PROTECTIVE …
report of suspected child abuse (child protective service law - title 23 pa csa chapter 63) please refer to instructions on reverse side. except for signature. please print or type 1. name of child (last, first, initial) soc. sec. no. birthdate sex mf address (street, city, state & zip code) county 1a. ................
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