Get Ombudsman Intake Case Complaint Form - Advocacy-inc

This guide provides clear instructions on how to complete the ombudsman intake case complaint form - Advocacy-inc online. It is designed to assist users at all levels of experience, ensuring a straightforward and efficient process.

Follow the steps to successfully complete your complaint form.

1. Click the ‘Get Form’ button to access the ombudsman intake case complaint form and open it in the editing interface.
2. Fill in the program name where indicated. This is typically the name of the specific long-term care ombudsman program relevant to your complaint.
3. Enter the date of intake. Use the provided format to ensure clarity and accuracy.
4. Complete the section for intake documentation. Include information about the person responsible for intake and the case number if applicable.
5. Provide your name as the complainant, along with your phone number and address. Ensure that your contact information is accurate to facilitate communication.
6. Indicate whether the complaint pertains to an individual or a group, and specify the number of residents involved if applicable.
7. Select your role as the complainant from the options provided, such as resident, relative, non-relative guardian, or other roles as appropriate.
8. Fill in the facility name, phone number, and address related to the complaint, ensuring to double-check the accuracy of this information.
9. Provide the name of the resident involved in the complaint and the date of the first action taken regarding the complaint.
10. Summarize the case or complaint clearly in the designated section, outlining key points and the nature of the complaint.
11. Complete the gender and phone number fields for the resident if required.
12. Document the date(s) and any notes from the case in the journal notes section, attaching any additional pages if necessary.
13. Select the appropriate disposition codes based on the outcome of the complaint discussion, following the provided guidelines.
14. Allocate time spent on the case in hours and minutes as required.
15. Indicate the name of the ombudsman closing this case and include the date of closure.
16. Review all sections of the form for accuracy and completeness. Once confirmed, you can save changes, download, print, or share the form as needed.

Complete the ombudsman intake case complaint form online to address your concerns effectively.