Implicit in the concept of documentation is a process of gathering information to document. To document properly, it is necessary to work through the processes of screening, assessment, and planning. Documentation is crucial to current attempts to address the problem and is essential for future attempts to track the clinical course and assess the value of interventions. Documentation, therefore, has value at both the case level and the policy level. Most State laws mandate the reporting of suspected elder abuse, and many laws specifically require members of the health care professions to report. Documentation is facilitated when fact-finding has been organized through the use of assessment tools. In describing how to document a case of elder abuse, this chapter considers how to collect demographic data, psychosocial data, caregiver data, medical history, data on patient/client observation, laboratory data, environmental data, and data on assessment and plan. 7 tables, 22 references, and appended mini-mental state inpatient consultation form