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http://www.floridahealth.gov/licensing-and-regulation/enforcement/_documents/complaint-form-2015.pdf
Health Care Provider Complaint Form This information MUST be completed to investigate your complaint, as we correspond via U.S. mail. Incomplete forms CANNOT be processed.
https://www.doh.wa.gov/LicensesPermitsandCertificates/FileComplaintAboutProviderorFacility/ComplaintForms
Forms to file a complaint against a health care provider or facility. This includes forms in the Spanish language, and the complaint form for the Nursing and Medical Commission professions.
https://www.osha.gov/workers/file_complaint.html
You (or your representative) have the right to file a confidential safety and health complaint and request an OSHA inspection of your workplace if you believe there is a serious hazard or if you think your employer is not following OSHA standards. The complaint should be filed as soon as possible after noticing the hazard.
https://www1.health.gov.au/internet/main/publishing.nsf/Content/maif-cf
Complaint form to be used for the lodgement to the Department of Health of an alleged breach of the MAIF Agreement. Complaint form to be used for the lodgement to the Department of Health of an alleged breach of the MAIF Agreement. Find updated information on the ...
https://www.health.ny.gov/professionals/doctors/conduct/file_a_complaint.htm
File a Complaint. If you wish to file a complaint, please review How to Choose the Right Physician - How to Tell Us if You Don't before printing and filling out a complaint form.. If you have a complaint or need information about professionals other than physicians, physician assistants or specialist assistants, please contact the New York State Education Department.
https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/FileAComplaint.aspx
Anyone can file a complaint against a health-care facility -- a patient or facility resident, a relative or friend, even a general member of the public. Online. Filing a complaint through the California Health Facilities Information Database (Cal Health Find) is the most direct way. You file the complaint and it is routed directly to the district office that has oversight authority for the facility in question.
https://www.dmhc.ca.gov/FileaComplaint.aspx
You have the option to submit your IMR/Complaint form either online, by mail or by fax. Be sure to complete all fields, include any copies of supporting documents and if applying by mail or fax - sign the form. You must submit your IMR/Complaint Form to the DMHC within six months after your health plan sends you a written decision about your issue.
https://www.michigan.gov/lara/0,4601,7-154-89334_63294_72973---,00.html
The Bureau of Community and Health Systems (BCHS) accepts and processes complaints against various state licensed and federally certified health facilities, agencies, and programs. To file a complaint against a state licensed or federal certified health facility, including nursing home, hospitals ...
https://www.tn.gov/health/health-professionals/hcf-main/filing-a-complaint.html
When a problem is experienced with a specific licensed and/or certified facility, you should file your complaint with the Division of Health Care Facilities. You have two options for filing your complaint: Centralized Complaint Intake Unit. You may phone your complaint to one of our medically trained staff by contacting Health Care Facilities, Complaint Intake Unit.
https://www.ombudsman.org.uk/making-complaint/complain-us-getting-started/complaint-forms
Before you download a complaint form Please make sure that we are the right organisation to look at your complaint and that it is ready for us. If you are not sure, our complaint checker tool 'Can we look into your complaint?' will help you. It only takes a few minutes.
https://www.state.nj.us/health/healthfacilities/file_complaint.shtml
File a Complaint about a Health Care Facility. Online. The Division takes on-line complaints. OR You can file a complaint by phone if you do not want to provide your name. By Phone. Complaint Hotline: 1-800-792-9770 . The 24-hour hotline handles consumer complaints and facility emergencies seven days a …
https://www.mass.gov/service-details/complaint-forms
Complaint Forms This Complaint Form was created by the Department of Mental Health (DMH) and may be downloaded from the table below and completed by anyone wanting to make a complaint about dangerous, illegal, and/or inhumane conditions or treatment experienced by a DMH client or anyone receiving services from a program or facility licensed or operated by DMH or contracted with DMH.
https://apps.ahca.myflorida.com/hcfc/
Health Care Facility Complaint Form. If you think a health care facility may have violated the law relating to your care, or the care of someone you know, please provide as much detail as possible in the boxes below. When completing the “narrative” portion of the form, please include full names of patients/residents, and staff involved. ...
http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/index.html
Florida Department of Health Enforcement. Influenza. Influenza or 'flu' is a viral respiratory illness, mainly spread by droplets made when people with flu cough, sneeze or talk. Influenza can cause mild to severe illness. Serious outcomes of flu infection are hospitalization or death.
https://www.michigan.gov/documents/lara/BCHS_Facility_Complaint_Form-361_517391_7.pdf
HEALTH FACILITY COMPLAINT FORM M ichigan Department of Li censing and Regulatory Affairs (LARA) Bureau of Community and Health Sy stems 611 W. Ottawa St reet, P. O. Box 30664 Lansi ng, MI 48909 Please print clearly or type inform ation on all sections of this form.
https://apps.health.ny.gov/surveyd8/nursing-home-complaint-form
Complaints will be accepted if the occurrence is within the past year of the submission of your complaint to the NYS Department of Health. In order to process your complaint in a timely manner, please: Type or Print clearly Complete form in its entirety, including your contact information
http://www.dph.illinois.gov/sites/default/files/forms/healthcare-facility-complaint-form-061118.pdf
of Public Health’s Central Complaint Registry at the address/numbers provided above. You may also complete the form and click the submit button for the form to be automatically sent to the Central Complaint Registry email inbox. Please be sure to fill out the form completely so a proper investigation may be completed.
https://health.maryland.gov/ohcq/Pages/Complaints.aspx
The online complaint form will allow you to upload any supporting documentation Complete and mail in a Paper Complaint Report Form. Please submit documentation supporting your complaint with the complaint form when you return it to the Office of Health Care Quality either by mail or fax.
https://portal.oho.qld.gov.au/healthcomplaintform/
Online health service complaint form. If you’re not satisfied with a service provided by a health service provider, or you’re concerned with the health, conduct or performance of a registered or unregistered health practitioner, then it is your right to make a complaint.
http://www.ldh.la.gov/index.cfm/page/254
Complaint forms received by Health Standards Section are reviewed and a determination is made as to the course of action. Once the complaint report is reviewed, the complainant will receive written notice of the department’s decision.
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