(a) A written abuse report, as required by this chapter, shall be submitted in one of the following ways:

1. (1) On a form adopted by the State Department of Social Services after consultation with representatives of the various law enforcement agencies, the California Department of Aging, the State Department of Developmental Services, the State Department of State Hospitals, the division, professional medical and nursing agencies, hospital associations, and county welfare departments. These reporting forms shall be distributed by the county adult protective services agencies and the long-term care ombudsman programs. This reporting form may also be used for documenting the telephone report of a known or suspected instance of abuse of an elder or dependent adult by the county adult protective services agency, local ombudsman program, and local law enforcement agencies.

2. (2) Through a confidential internet reporting tool, if the county or long-term care ombudsman program chooses to implement such a system. This internet reporting tool shall be developed and implemented in a manner that ensures the confidentiality and security of all information contained in the reports, pursuant to the confidentiality standards set forth in Sections 10850, 15633, and 15633.5.

   1. (A) A county or long-term care ombudsman program that chooses to implement this system shall report to the Assembly Committee on Aging and Long-Term Care, the Assembly Committee on Human Services, the Senate Committee on Human Services, the Assembly Committee on Public Safety, and the Senate Committee on Public Safety one year after full implementation. The report shall include changes in the number of mandated reporters reporting through the confidential internet reporting tool, changes in the number of abandoned calls, and any other quantitative or qualitative data that indicate the success, or lack thereof, in employing a confidential internet reporting tool to better protect the safety and financial security of elder and dependent adults.
   2. (B) Information sent and received through the confidential internet reporting tool shall be used only for its intended purpose and shall be subject to the same confidentiality and privacy requirements that govern nonelectronic transmission of the same information, and that are set forth in Sections 10850, 15633, and 15633.5.

(b) The form required by this section and the confidential internet reporting tool, if implemented, shall contain the following items:

1. (1) The name, address, telephone number, and occupation of the person reporting.
2. (2) The name and address of the victim.
3. (3) The date, time, and place of the incident.
4. (4) Other details, including the reporter’s observations and beliefs concerning the incident.
5. (5) Any statement relating to the incident made by the victim.
6. (6) The name of any individuals believed to have knowledge of the incident.
7. (7) The name of the individuals believed to be responsible for the incident and their connection to the victim.

(c)

1. (1) Each county adult protective services agency shall report to the State Department of Social Services monthly on the reports received pursuant to this chapter. The reports shall be made on forms adopted by the department. The information reported shall include, but shall not be limited to, the number of incidents of abuse, the number of persons abused, the type of abuse sustained, and the actions taken on the reports. For purposes of these reports, sexual abuse shall be reported separately from physical abuse.
2. (2) The county’s report to the department shall not include reports it receives from the long-term care ombudsman program pursuant to subdivision (d).
3. (3) The department shall refer to the division monthly data summaries of the reports of elder and dependent adult abuse, neglect, abandonment, isolation, financial abuse, and other abuse it receives from county adult protective services agencies.