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indianaattorneygeneral.secure.force.com

Maindomain:force.com

Title:forcecom

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Website / Domain: indianaattorneygeneral.secure.force.com
HomePage size:48.835 KB
Page Load Time:0.329513 Seconds
Website IP Address: 96.43.152.167
Isp Server: Salesforce.com Inc.

indianaattorneygeneral.secure.force.com Ip Information

Ip Country: United States
City Name: San Francisco
Latitude: 37.788463592529
Longitude: -122.39460754395

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indianaattorneygeneral.secure.force.com Httpheader

Date: Tue, 25 Feb 2020 23:23:38 GMT
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96.43.152.167 Domains

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REPORT PATIENT ABUSE AND NEGLECT Please fill out the following forms as completely and accurately as possible. The more detailed the information you provide, the more efficient and effective our staff can be in their investigation of the incident reported. 1. Contact Information Salutation --None-- Mr. Mrs. Ms. Dr. * First Name Middle Name * Last Name * Address * City * State --None-- IN AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY * Zip Code * Email Phone * Victim Name * Name of residential care facility Street Address of residential care facility * City of residential care facility State of residential care facility --None-- IN AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip of residential care facility * County of residential care facility "If unknown, type N/A" * Approximate date of alleged abuse and/or neglect Have you reported the alleged abuse and neglect to the Police Department? --None-- Yes No Not sure Name of Department Case # (if known) * Description of alleged abuse and/or neglect (please be as thorough as possible) Have you reported the alleged abuse and neglect to either of the following state government agencies? Indiana State Department of Health --None-- Yes No Not Sure Adult Protective Services --None-- Yes No Not sure If you have supporting documentation or materials related to this complaint that you would like to upload at this time, please check the box below. After you click the Submit button below you will be directed to another page where you can upload those files....

indianaattorneygeneral.secure.force.com Whois

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