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Request for APS Records

Non Law Enforcement

This form is for individuals to request confidential Adult Protective Service (APS) Records.

By completing this form you are attesting that:

1) You are a person entitled to the records under SDCL 1-36A-29.1

2) It is necessary for you to have this information in the performance of your official functions relating to abuse, neglect, or exploitation of the person whose records you are requesting. (or “for whom you are requesting records

3) You will hold the information confidential except to the extent the court orders the release of the information for the determination of an issue before the court.

Requestor's Name

Requestor's Address

Identify your realtionship to the adult who is the subject of the information

Upload any supporting documentation of your role

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Once you submit this form a DHS employee will initiate a response to your request within 5 business days. The response will go to the email provided.

Receipt

You will be provided with a Receipt upon submission.