DCFS Suspected Child Abuse/Neglect Referral Information Request Completed Form Examples and Samples
Explore professional examples and samples of the DCFS Suspected Child Abuse/Neglect Referral Information Request form. Learn how to accurately complete and process these critical child welfare documents with our detailed templates.
Automated Processing of DCFS Suspected Child Abuse/Neglect Referral Information Request
How this form was filled:
This example demonstrates how an AI can parse an unstructured social worker's field narrative to populate a formal DCFS Suspected Child Abuse/Neglect Referral Information Request. The AI intelligently filters relevant investigative data from internal case notes, ensuring administrative compliance without manual data entry.
Source document used: Social Worker Field Investigation Narrative
Case Narrative: 2026-08-14. Today I followed up on the report regarding 7-year-old Leo Thompson. I met with his primary caretaker, his aunt Sarah Thompson, who has been looking after him for the past six months. Upon arrival at the home, I noted several alarming conditions. First, Leo presented with a suspicious, unexplained circular bruise on his upper left shoulder. Furthermore, he displayed signs of extreme physical neglect, specifically untreated dental decay that is causing him visible pain. Additionally, there were fresh scratch marks across his forearms. When I asked Sarah about the injuries, she claimed that Leo fell off his bicycle last Tuesday and that she hadn't realized the severity of the toothache, citing financial hardships. I have already looped in our case supervisor, Marcus Vane, who can be reached at 555-019-8823 for oversight. My direct contact at the district office remains Janet Sterling; she is available for updates at 555-012-9900 or via our secure fax line at 555-012-9901. During the interview, it became clear that this household is struggling significantly, with evidence of ongoing substance abuse issues and documented instances of domestic violence between the aunt and her partner, which Leo has clearly witnessed. I am opening this under case number #DCFS-88921-X. I am requesting an urgent follow-up response by August 20th, 2026, to ensure the safety plan remains viable for the child.
Information used to fill out the document:
- Child Details: Leo Thompson, Case #DCFS-88921-X
- Caretaker: Sarah Thompson (Aunt)
- DCFS Contact: Janet Sterling (555-012-9900 / Fax: 555-012-9901)
- Supervisor: Marcus Vane (555-019-8823)
- Concerns: Physical abuse, neglect, substance abuse, and domestic violence
- Parent Explanation: Alleged bicycle accident and dental neglect due to financial hardship
- Key Dates: Referral Date: 2026-08-14, Response Requested By: 2026-08-20
What this filled form sample shows:
- Contextual entity extraction from narrative prose
- Normalization of phone and fax numbers into form formats
- Boolean logic mapping for checkbox fields like 'Substance Abuse' and 'Domestic Violence'
- Temporal alignment of investigation date versus response deadline
- Role-based entity classification (Caretaker vs. Supervisor vs. DCFS Official)
Form specifications and details:
| Form Name: | DCFS Suspected Child Abuse/Neglect Referral Information Request |
| Use Case: | Automated Social Services Data Intake |
| Data Source: | Unstructured Field Notes |
| Accuracy Requirement: | High (Compliance-driven) |
| Target Audience: | Caseworkers and Administrative Staff |
| Categories: | referral forms |
| Created: | May 25, 2026 10:01 PM |