Child Abuse Pediatrics Consult

Emergent PEDS referrals: Those situations when an FCM needs to speak with a PEDS team member immediately (i.e. need immediate medical advice).
  • Page the child abuse pediatrician on call directly by dialing (317) 312-2911 and then entering your complete phone number (including *extension) followed by the #sign.
  • You may also reach the child abuse pediatrician on call by paging through the operator at 317-944-5000.
  • Note: DO NOT ASK FOR THE "PEDS DOCTOR." (Almost every doctor at Riley is a Peds doctor = pediatrician.)
  • After speaking with the CPP provider on call, please submit a referral in order to complete the referral and receive feedback to the DCS central office.
Sexual abuse concerns:
  • DO NOT COMPLETE A PEDS referral.
  • URGENT sexual abuse concerns - Page the Riley Center of Hope Triage Nurse on call by paging through the operator at 317-944-5000.
  • Non-Urgent sexual abuse concerns - Call the Pediatric Center of Hope at 317-274-7377 to speak to a clinic nurse.
Medical Impression: The medical impression is based on the information provided and is only one component of the information needed for DCS assessment. The medical impression may change if additional information becomes available. The medical impression is not sufficient for court without a formal report. If you have questions or need further clarification, please call 317-274-7401.
Please select a referral type:
  • Suspected skin injury (bruises, cuts, welts, abrasions) for child 0 to less than 12 months
  • Suspected head/neck injury for child 0 to less than 6 years old
  • Suspected fracture for child 0 to less than 3 years old
  • Suspected burn for child 0 to less than 3 years old
  • Any that do not meet the above criteria.
  • However, FCMs may submit non-mandatory referrals if they have questions or need assistance from the PEDS team.
Today's Date
Date of DCS Report
DCS FCM
County
Phone Number
Fax Number
Phone Ext
DCS FCM Email
DCS Supervisor
LE Contact
MAGIK #
Child's Name
DOB
Age
Mother's Name
Father's Name
Name of Hospital
Physician
Location of Child
Brief description of the case (Date, Caregiver at time of injury, explanation given by all parties involved i.e. child, parent, caregiver, etc):
Please Explain:
Please Explain:
Please Explain:
Please Explain:
Please Explain:
Please Explain:
Please Explain:
Injuries Identified (Any Known Pre-Existing Medical Conditions, Current Condition):
What laboratory or x-ray tests were done, if any?
Prior DCS history for abuse or neglect?
Prior DCS history details:
Previous childhood injuries/deaths?
Previous childhood injuries/deaths details:

DV/IPV

Remember that children in homes in which there is DV/IPV are 40-60 times more likely to be victims of maltreatment themselves. (Thackeray et al., 2010)
Current incident involves allegation of DV?
History of DV occurring in the home?
Child was physically injured (Dropped, Pulled, Thrown, Hit) as result of DV incident?
Child witnessed (Heard And/Or Saw) DV incident?
Law enforcement was involved at scene of DV Incident?
If the answer to any of the above items is yes, please explain:

General Concerns

Does the parent of the child have a history of victimization as a child?
How concerned are you about the child's overall safety in their current home environment?
How concerned are you that the injury is inflicted?
Additional information

Pets

History of animals being purposely harmed/killed in the household?
If child has injuries, was a pet blamed for causing them?
If the answer to any of the above items is yes, please explain:

Siblings

Name
DOB
Current Location
Medical Eval Done?
Name
DOB
Current Location
Medical Eval Done?
Name
DOB
Current Location
Medical Eval Done?
Which Child Protection Program Team Member did you speak with? To facilitate the referral, remember to CALL and speak with to a Child Protection Team Member before you submit your referral.
Other CPP Member:
Voicemail Date/Time:
If you have additional questions after speaking with the CPP member above, please list here (If no questions, please put NA):

Any additional information such as photos, records, release of information, etc. can be sent via email to iucpp@iu.edu Please reference the child's complete name in the subject line. Additional information can also be sent to the physician's attention at:

IU Child Protection Program
c/o Riley Hospital
575 Riley Hospital Dr.
XE 040
Indianapolis, IN 46202

* To attach a document or photos please use the button below. Hold the control key to select multiple files.
* You can upload no more than 10240 KB (10 MB) of data at a time. The UITS attachment filters block the following file types:
.ade .adp .app .asp .bas .bat .chm .cmd .com .cpl .crt .csh .exe .fxp .hlp .hta .htr .inf .ins .isp .jar .js .jse .ksh .lnk .mda .mdb .mde .mdt .mdw .mdz
.mht .msc .msi .msp .mst .ops .pcd .pif .prf .prg .reg .scf .scr .sct .shb .shs .url .vb .vbe .vbs .wsc .wsf .wsh. The message contains a .zip file attachment that contains one or more of the blocked file extensions.
(Note: x-ray images on CD must come by mail-suggest overnight) Thank you for your referral. We look forward to working with you.
* The form will be submitted to IUCPP and a copy will be sent to the DCS FCM e-mail noted above.