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WELFARE AND INSTITUTION CODE 4731 COMPLAINT FORM. INVESTIGATION REQUEST. DS 255 (New 8/2007) (Electronic Version) ... (City). ( State). (Zip). Name of Consumer. Birth Date (Month, Date, Year) .

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Remit Date - Dshs State Tx FOR DSHS USE ONLY - Dshs State Tx Remit # - Dshs State Tx November 2013 - Texas Department Of State Health Services

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Once all pertinent information has been received in CCU, the Board staff will analyze the information to determine if there is sufficient evidence for referral to a medical consultant. If referral to a medical consultant is warranted, the complaint is forwarded to a consultant for a thorough review.

Sexual misconduct, impairment (drug, alcohol, mental, physical) Unlicensed practice, or aiding and abetting unlicensed practice. Unprofessional conduct (breach of confidence, record alteration, filing fraudulent insurance claims, misleading advertising, arrest or conviction)

You must submit your IMR/Complaint Form to the DMHC after your health plan sends you a written decision about your issue.

Hotel Complaint Resources: Department of Consumers Affairs - (800) 952-5210 or .dca.ca.gov.

Telephone complaints Environmental Health Customer Call Center at (888) 700-9995 Monday - Friday from 8:00 a.m. - 5:00 p.m., excluding Holidays.

WHAT IS THE CONSUMER COMPLAINT PROCESS? Section 4731 of the Welfare and Institutions Code (W&I Code) permits each consumer or any representative acting on his or her behalf, to pursue a complaint against a regional center, developmental center, or provider.

1-800-300-1506. If you have a Medi-Cal Managed Care plan, you can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609 for guidance about how to address a problem or complaint. The office is open 8am-5pm/ Monday to Friday.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232