FREE 11+ Health Complaint Form Samples in PDF | MS Word

Along with an individual’s intellectual property, cars, houses, and money, health is considered as  one’s wealth which can either drive him or her to success or be the reason for his or her failure. This is why doctors, private sectors, and government agencies promote programs for the people around them in order to aid the society in having a better well-being. However, some people always seem to desire more for a particular service or are often experiencing unsatisfactory services from the medical professionals which will then lead to the process of filing a health complaint.

Health complaint forms are documents which will highlight the complaints of a patient, health insurance members, and even the medical staff with regards to health-related issues. This complaint form will have the information of the complainant, the main issue or the problem of why there is a need to file the complaint, and the possible solutions to meet the satisfaction of the complainant. After the completion of the health complaint form, the complainant may then submit the document to the health personnel who is assigned to deal with specific issues in various departments of the company.

Health Complaint Intake Form

Health Professions Complaint Form

How to Report a Health Complaint

Reporting a health complaint can be done by doing the following:

• Writing. This requires the individual or the complainant to construct a formal letter for the agency where his complaints are addressed. The essential elements of a letter must be included such as the heading which is the return address, the inside address, the salutation, body of the letter, a closing, and the signature of the complainant.

• Calling. Most health agencies and companies have toll-free hotlines which can be contacted 24/7 by their clients. With this, the complainant must have the contact information of the agency to let him reach and report his complaint immediately. The complainant must inform the customer service representative on the phone about his concerns for the representative to report the complaint to the right person who is knowledgeable about the issue.

• Filing. If the complaint was not fixed by merely reaching them through the phone, the complainant can proceed in filling out a complaint form directly for the management. However, this must be the last option, only when things become out of hand, and if an immediate resolution is needed for the patient or for any individual who is affected by the incident.

Health Care Bureau Complaint Form

Health Plan Complaint Form

Types of Health Complaint Forms

Environmental Health Complaint Form – This complaint form focuses on issues related to the environment such as food-related illnesses, smoke-belching vehicles, as well as pests living in a specific location. The complainant must assure that he is stating enough descriptions about these issues to fully inform the health authority of the country and to avoid other people catching the illness and become a victim of the issue. An environmental health officer is expected to deal with an environmental health complaint and be the one to conduct an inspection in the reported area to gather data which can be used to supply more details about the complaint.

Environmental Health Complaint Form

Health Department Complaint Form – In any country, there will be a government agency who centers on health and medical issues and resolutions. These agencies use a health department complaint form for their complainants which includes an area to be completed by their assigned personnel. The personnel must enlist the pieces of evidence which are presented as well as the container or the material of the package which was sent by the complainant. The findings of the complaint will be stated at the bottom of this legal form along with the suggestions provided by the assigned personnel.

Health Department Complaint Form

Health Care Provider Complaint Form – Health care providers are people responsible to cure patients, recommend medicine dosages, and even conduct a surgery. They may be professionals who acquired a particular degree in their education and in their job positions, but they are not immuned to face varieties of complaints from their clients. With a health care provider complaint form, the name of the health professional who the tenant wishes to file a complaint against will be stated. An authorization for a medical records release must also be signed by either the patient, the complainant, or the person who is authorized in making health-related decisions for the patient to allow the health care agency in collecting relevant details about the patient for the investigation of the issue.

Health Care Provider Complaint Form

Health Facility Complaint Form – The facilities and materials in a medical or healthcare center must comply with the standards of a country. Nonetheless, if a patient or an individual have seen a faulty or an unsatisfactory quality of care and equipment safety, the patient may complete a health facility complaint form. This will state the location and the details of the incident that resulted in having the patient file the complaint, as well as the specification of whether the complaint is about nursing care issues, medical care, environmental, accessing medical reports and records, patient rights and safety issues, and patient discharging issues.

Health Facility Complaint Form

Health Information Privacy Complaint Form – The personal health information of an individual or a patient should be kept confidential by any healthcare agency and organization. In the event that an agency has violated a patient’s privacy rights, the patient may file a health information privacy complaint to the management or the authorized government agency who will deal with his privacy issues and concerns. Along with a privacy complaint form is an enclosed complainant consent form to state the intention of the authorized personnel in collecting and receiving materials about the patient’s health records and history. The complainant should indicate his choice, and affix his or her signature on both forms to signify his or her consent.

Health Information Privacy Complaint Form

Health Service Complaint Form – This deals with the particular service which is the subject of an individual’s complaint. The form can be used to complain about ambulance or hospital vehicle services, dental services, the provided services of the hospital staff, as well as the social workers in a government health agency. Allegations with regards to health personnel who have declined or refused to grant a service may also be included as the reason why the complaint is submitted. The complainant, however, must assure that he will not go beyond the time limit such as twenty-four months after the incident, stated on the form which determines if the complaint will be accepted or not. Service complaints which are submitted beyond the limit may no longer be entertained by the management since a priority will only be given to recent complaints.

Health Service Complaint Form

Mental Health Complaint Form – The departments of mental health in any country are built to cater the needs of people dealing with abusive elements and experiences in the society. Mental health institutes should be helping their patients cope up and continue living their lives to become normal once again. However, there are some instances that patients tend to harm their doctors while on a reverse, some mental health professionals cause an even more abusive experience to their patient. With this, a vigilant individual such as the relative of the patient or a concerned member of the staff may use a mental health complaint form to indicate and describe his concerns. The form will have seven entries having the names of the complainants, the clients who have been harmed or affected by the issue, the name of the person who will be complained as well as the individual who is identified as the complainant, the date of the incident, the location of where the incident occurred, and an in-depth or detailed statement about how the incident happened.

Mental Health Complaint Form

Occupational Safety and Health Complaint Form – Employees in any working industry should be guaranteed that they are safe in the environment of their workplace. If imminent danger and risks are present in the workplace, and yet have not been resolved by the company management, the employee can fill out an occupational safety and health complaint form to the authorized government agency to start an incident report. The form should have the basic information of the company and the location where the risks and hazards are evidently seen. The employee may indicate on the form as to whether he prefers to be unnamed or if he wants to be called up during the building inspection of the premises. The choice to remain anonymous is given to allow any public employee to freely report incidents and violations without the fear of being fired from his or her job position.

Occupational Safety and Health Complaint Form

Health Agency Complaint Report Form

Health Complaint Report Form

Though immediately filling out a health complaint form may be an effective move that a complainant can do, considering to acquire a negotiation with the health service providers might also work especially if there are minor issues in the complaint. Complaints are used to address a problem, rather than maligning the health organization. The providers must also assure that they will attentively listen to their clients since the complaints are tools for their company to create bridges and address gaps that may have been invisible in their own sights.