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https://www.mass.gov/service-details/complaint-forms
DMH Complaint Form 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 …
https://dbh.dc.gov/service/file-complaint-or-incident-report
To file a complaint about a substance abuse treatment program certified by APRA, you must complete the Substance Abuse Complaint Form [PDF]. The form must be filled out completely and it must be signed and dated. APRA will investigate your concerns based on the information you provide.
https://www.dmhc.ca.gov/FileaComplaint.aspx
For your convenience, an IMR and Complaint can be submitted to the DMHC on one IMR/Complaint form. 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.
https://www.mass.gov/dmh-forms
DMH Forms Forms for both Providers and Individuals Served This page serves as a central directory for all DMH related forms for individuals, families, and providers.
http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx
Authorized Assistant Form. If you want to give another person permission to help you with your Independent Medical Review (IMR) or Complaint, use the form below. You have the option to send the form either as an attachment with your online IMR/Complaint Form, or with your supporting documents by …
https://dmh.lacounty.gov/our-services/forms/
Clinical Forms; Clinical Practice; Pharmacy; Training & Workforce Development; Student Professional Development Program; Web Based Training & Meeting Solution; Service Request Tracking System (SRTS) Outcomes; About DMH. DMH Leadership Team; Mental Health Commission; Service Area Advisory Committee (SAAC) Underserved Cultural Communities (UsCC ...
http://www.file.lacounty.gov/SDSInter/dmh/159183_Grievance,AppealForm_English.pdf
AUTHORIZATION FORM You may file a GRIEVANCE at any time. You may authorize another person to act on your behalf. You have the right to file an APPEAL with the Patients’ Rights Office or to request a STATE FAIR HEARING when the Local Mental Health Plan: 1. Denies or limits authorization of a requested service; 2.
https://dmh.lacounty.gov/our-services/patients-rights/
The Patients’ Rights Office was created in response to California legislation requiring each county mental health director to appoint patients’ rights advocates to protect and further the Constitutional and statutory rights of mental health care recipients. Also available on this page are the Beneficiary Client Grievance Forms...
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.
Crisis Hotline Coping with Disaster Real Voice Real Choices Conference Suicide Prevention 1-800-273-TALK (8255) Missouri Institute of Mental Health Midwest Special Needs Trust
http://mhlac.org/wp-content/uploads/2018/10/dmh_complaint_process.pdf
Department of Mental Health Central Office of Investigations 25 Staniford Street Boston, MA 02114 If you have additional questions in regards to filing a DMH Complaint Form, you may call the DMH Director of Investigations at 617-626-8108 or the DMH Central Office of Information and Referral Specialist at …
http://www.dmh.ms.gov/providers/professional-licensure-and-certification-place/
DMH PLACE Professional Credentialing Complaint Form: This is the official form for filing a complaint with the Mississippi Department of Mental Health (DMH) Division of Professional Licensure and Certification (PLACE).
http://file.lacounty.gov/SDSInter/dmh/159114_HIPAAComplaintFormsEnglish.pdf
Mail the complaint to County of Los Angeles – Department of Mental Health, Patients’ Rights Office, 550 South Vermont Avenue, Los Angeles, CA 90020. You may also file a complaint with the Office for Civil Rights, U.S. Department of Health & Human Services. Signature of Client/Client’s Representative/ Person Submitting Complaint Date
http://www.dmh.ms.gov/get-help/dmh-ocs/
A variety of services for mental health, IDD, alcohol and drug addictions, and Alzheimer’s disease and other Dementia are available across the state. To find the nearest DMH Certified Service Providers in your area, use the search form below and enter your county.
https://www.health.ny.gov/forms/doh-3867.pdf
INSTRUCTIONS FOR COMPLETING COMPLAINT FORM To file a complaint about a physician (M.D. or D.O.), Physician Assistant or Specialist Assistant licensed to practice medicine by the State of New York, please complete this form and mail the original to: NYS Department of Health Office of Professional Medical Conduct Riverview Center 150 Broadway ...
Find a Mental Health Program. The program directory allows you to: Search for mental health programs by county, program category or subcategory. View program details including program name, address and phone number. Click on any county on the map to view all of the programs in that county.
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. Department of Health Complaint Form Find updated information on the coronavirus (COVID-19) health alert
https://www.dhcs.ca.gov/Pages/File_a_Complaint.aspx
Nov 09, 2018 · An Ombudsman is a person in a government agency who can assist you with complaints or explain problems with the programs or policies of the agency . Contact the Ombudsman for assistance with the following services: Navigating through the Medi-Cal Managed Care System ; Finding information to help access mental health services
https://www.doh.wa.gov/LicensesPermitsandCertificates/FileComplaintAboutProviderorFacility
Complaint forms. Health professional complaint information; Health facility complaint information. Adult Family Homes, Assisted Living Facilities, Nursing Homes/Skilled Nursing Facilities, Supported Living, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID, including Rainier School, Fircrest, and Lakeland Village), and Enhanced Services Facilities, which ...
https://health.mo.gov/safety/healthservregs/complaints.php
Complaints may be submitted in several ways. Complaints may be phoned to the department directly at 1-800-392-0210. You may email your complaint to [email protected]. You may also print and complete a complaint form. Once completed, this form should be mailed to: Missouri Department of Health and Senior Services
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