Get Ny Doh-3867 2020-2025

Filing a complaint regarding a physician or physician assistant can be a vital step in addressing professional misconduct. This guide will provide a comprehensive overview of filling out the NY DOH-3867 form online, ensuring you understand each component for a smooth experience.

Follow the steps to complete the NY DOH-3867 form effectively.

1. Click ‘Get Form’ button to access the NY DOH-3867 form and open it in the appropriate online environment.
2. Fill in your personal information in the 'Information About You' section. This includes your name, address, and telephone numbers. Ensure that you provide accurate contact details.
3. In the 'Your Complaint Regarding a Physician or Physician Assistant' section, enter the name and address of the physician or physician assistant you are filing a complaint against.
4. Complete the 'Information About the Patient(s)' section if applicable. Enter the patient's first and last name, date of birth, and middle initial.
5. In the 'Details of Your Complaint' section, describe your complaint in detail. Include the time and location of the incident, and state whether you have reported this to anyone else.
6. If there are witnesses, list their names in the provided area. You may add additional witness names on a separate sheet of paper if necessary.
7. Sign and date the form at the bottom. Remember to review all provided information for accuracy.
8. Once you have completed the form, save any changes made, and then download, print, or share the form as needed. Make sure to mail the original signed form to the specified address.

Take action today and file your complaint online to address your concerns.