Get Tx Individual's/patient's Complaint Form 2019-2026

Filing a complaint with the Texas Board of Nursing can be a vital step in addressing concerns about nursing practice. This guide will walk you through the process of completing the TX Individual's/Patient's Complaint Form online, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to fill out the complaint form effectively.

1. Click ‘Get Form’ button to obtain the TX Individual's/Patient's Complaint Form and open it in the editor.
2. Provide the information about the nurse being reported. Fill in their full name, license number, social security number, date of birth, phone number, employer's name, address, and employer's phone number.
3. Detail the incident or conduct being reported. Include the date(s), time of the incident(s), facility/unit where the incident occurred, the patient’s name and date of birth or other identifier, and a clear description of the incident or conduct.
4. If there are witnesses to the incident, provide their full names, titles or positions, direct dial phone numbers, email addresses, and a brief description of what each witness observed related to the incident or conduct.
5. Complete the complainant information section. This includes your name, address, city, state, phone number, zip code, and email address. Be sure to sign and date the form.
6. Once you have filled out all sections, review the form for accuracy, then save any changes you have made. You can choose to download, print, or share the completed form as needed.

Complete your complaint form online and ensure your concerns are addressed.