Effective Date
Instructions
Updated: 1/2016
Purpose
To document Adult Protective Services (APS) investigatory findings of Consumer Directed Services (CDS) employees, case managers or service coordinators, or Financial Management Services Agency (FMSA) representatives for individuals receiving services through the CDS option.
Procedure
When to Prepare
The FMSA must complete Form 1719 any time the FMSA receives a final investigatory report from APS, and send Form 1719 to the alleged perpetrator(s) within five business days after receipt of the APS final investigatory report. The FMSA will release the completed Form 1719 to the alleged perpetrator(s) identified on the report.
Number of Copies
Original and one copy.
Transmittal
The FMSA maintains the original in each service provider's file. The FMSA must send to the alleged perpetrator(s) identified on Form 1719 within five business days after receiving the final investigation report from APS.
Form Retention
The FMSA must keep this form for five years after termination of the service provider or until the resolution of all outstanding litigation, claims and audits.
Detailed Instructions
The FMSA uses the information found in the final investigatory report from APS to fill in the form fields and select the appropriate finding. A representative of the FMSA signs the form.