This government document is issued by Child Welfare Services for use in San Diego County, CA
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https://www.google.com/url?client=internal-element-cse&cx=015466730696295969998:wokiau6kw8k&q=https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/cs/cws/policies/child_abuse_reporting/Processing%2520DOJ%2520Form%2520BCIA%25208583.pdf&sa=U&ved=2ahUKEwiVorDbg_X4AhXuCRAIHYPjCsYQFnoECAkQAg&usg=AOvVaw0zjtc0lIxHL2YlOIDSYq_M