How to File a Health Information Privacy or Security Complaint

Website Accessibility. ADA Accessibility. Website Administrator. Toggle navigation menu. Important Information – Please read first The Consumer Affairs Branch responds to complaints concerning tenant-landlord, cable, consumer, taxicab, and towing. Complaints are resolved through voluntary mediation or arbitration between the parties. If you have a question or need advice about a consumer issue, contact Consumer Affairs at , TTY , to speak to a consumer specialist. Our business hours are a.

Make a Health Facility Complaint

Members may download one copy of our sample forms and templates for your personal use within your organization. Neither members nor non-members may reproduce such samples in any other way e. The environment of the company should be characterized by mutual trust and the absence of intimidation, oppression and exploitation.

Through enforcement of this policy and by education of employees, [Company Name] will seek to prevent, correct and discipline behavior that violates this policy. All employees, regardless of their positions, are covered by and are expected to comply with this policy and to take appropriate measures to ensure that prohibited conduct does not occur.

Appropriate disciplinary action will be taken against any employee who violates this policy.

Professional Geologist and Architect licenses with last names beginning with letters A-L must renew their professional license by the expiration date of.

It is important that you attempt to resolve your complaint with the company before filing with the Division of Consumer Protection DCP. Complaints already the subject of a lawsuit or other legal action cannot be handled by the DCP. Please be sure that your statement is complete and factual, but as brief as possible. The DCP will attempt to help you and the company reach a satisfactory settlement. However, we cannot require the company to make an adjustment. For Novel Coronavirus Price Gouging related complaints : When reporting, be prepared to provide details of the alleged price gouging to include the location of the merchant and any available proof of the excessive price s , such as receipts or pictures.

For “company information” please provide the alleged price gouging company’s information. For “complaint description” please include dates of the observation or purchase, and any information you may have to demonstrate that the same goods were being sold for a different price previously by the same seller or for a lesser price by other merchants in the same area.

Frequently Asked Questions: How to File a Complaint

OMB Control No. Form Expiration Date: September 30, You can file an Americans with Disabilities Act ADA complaint alleging disability discrimination against a State or local government or a public accommodation private business including, for example, a restaurant, doctor’s office, retail store, hotel, etc.

Describe your complaint: Provide details such as names, dates, amounts, type of securities, description of financial harm or abuse, etc. smallbutton * This is a.

Visit cdc. You should notify OCR immediately in the event of any retaliatory action. Complete as much information as possible, including:. You will then need to electronically sign the complaint and complete the consent form. After completing the consent form you will be able to print out a copy of your complaint to keep for your records. You will need Adobe Reader software to fill out the complaint and consent forms. You may either:. If you mail or fax the complaint, be sure to send it to the appropriate OCR regional office based on where the alleged violation took place.

OCR has ten regional offices, and each regional office covers specific states. You do not need to sign the complaint and consent forms when you submit them by e-mail because submission by e-mail represents your signature.

File a Complaint

You may file a complaint on-line or by phone against a facility or program licensed by MSDH if you believe you received poor quality care. Certain complaints are handled better by other agencies. If your problem concerns a mistreatment of an adult outside of a care facility, financial fraud, Medicaid or Medicare, a physician, nurse or medical clinic, please see our list of other agencies to contact.

If you would prefer to make a complaint by phone, call weekdays between 8 a. Please include as much information as possible on the form below. If you wish to remain completely anonymous do not complete the section “Who Is Filing This Complaint?

Date(s) of the incident(s); How and when you observed or became aware of the alleged violation; A description of the respondent’s actions and behavior which you.

Agency Directory Online Services. Talk to the person who sold you the product or service. If this person cannot help you, speak with a supervisor, then the store manager or owner. Be calm, courteous and friendly. Do not threaten. Be specific about wanting replacement, a refund or repair. If you are not satisfied, the faster you complain to us, the better your chances for a resolution. Include problem history with date and location of purchase; copies of all documents; and your work and home numbers.

Consumer Protection staff will contact the business. Although we cannot force a business to resolve a complaint, our contact with the company often results in a solution. We will contact you, once we have reviewed your complaint, typically within a week of receiving your complaint. To file a general consumer complaint online, click here. To submit a complaint to DATCP by mail, download a consumer complaint form in English or Spanish here or contact the Consumer Protection Hotline at to request a form by mail.

Presentar una Queja del Consumidor.

Consumer Complaints

The Health Standards Section investigates complaints against licensed health care providers. Health Standards does not investigate complaints involving billing, reimbursement or care provided in a setting not licensed by the Department of Health. The Health Standards Section has no authority over physicians. Please complete the complaint form in its entirety.

Purchase date and exact location where purchased. Results of any laboratory testing performed on the pet food product; How the food was stored.

It seems that JavaScript is not working in your browser. It could be because it is not supported, or that JavaScript is intentionally disabled. Some of the features on CT. For the latest information, visit ct. To protect the health and safety of the public and our employees, DCP employees will no longer be at Columbus Blvd. Please do not send mail.

Discipline Complaint Form

Do not provide answers to the questions below, as this will not be processed as a complaint, or included as part of your complaint. The official complaint form in Microsoft Word and PDF formats can be downloaded from the links below. To file a complaint, please print out the complaint form and submit it to the Iowa Civil Rights Commission.

Besides filing a complaint with the Iowa Civil Rights Commission, you may have other legal options. You may want to consult an attorney.

Be sure to sign and date your complaint. Send it to one of the regional offices of the Office of Professional Discipline. When your complaint is received, it will be.

When you are trying to resolve a complaint against a company, the first step should always be to discuss your concerns with a representative of the business. Try to speak with the manager or owner, and follow up by sending a certified letter confirming all the details of your conversation. Below you will find an example of a letter you can use to send to the business. If you are following up on a previous conversation, be sure to restate any assurances that were made to you at that time.

I am dissatisfied with your [service or product] because [describe problem]. I have already attempted to resolve this problem by [describe attempts and actions taken]. I have enclosed copies of my records. Unfortunately, the problem remains unresolved. Please contact me within [number of days] days to confirm that you will honor my request. I have prepared a complaint for submission to the proper agencies for investigation.

I will not file the complaint if you resolve the problem within this time period I have indicated.

Customer Service Speaker Explains How to Handle Complaints