Get Death Certificate Complaint Form - Oklahoma Board Of Medical ...

Filling out the Death Certificate Complaint Form can feel overwhelming, but this guide provides clear, step-by-step instructions to aid you in the process. Our goal is to support you in submitting your complaint accurately and efficiently.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the date at the top of the form. Ensure that the date you enter is accurate and reflects when you are submitting the complaint.
3. In the ‘Complainant’ section, provide your name, followed by your address. It is important to ensure this information is complete so that you can be reached for any follow-up.
4. Next, fill in your contact phone number and email address. If applicable, also include your fax number. This information will be necessary for any correspondence regarding your complaint.
5. In the ‘Licensee’ section, write the name of the person or entity you are filing the complaint against. Include their contact information as well to ensure clarity.
6. Provide the name of the deceased along with their date of birth (DOB) and date of death (DOD). This information is crucial for identifying the specific case you are addressing.
7. Indicate the place of death and check the appropriate box to specify whether the death was attended or unattended. If it was unattended, ensure you have the Medical Examiner’s (M.E.) information available.
8. In the next section, provide complete details regarding when, where, how, and by whom the death certificate was delivered to the physician. Be thorough in your description to provide the necessary context.
9. List any individuals or entities you have contacted about the delivery of the death certificate, including their response details. Be sure to include names, dates, contact information, and the nature of their response.
10. Finally, indicate your preferred method for the returned death certificate upon resolution of your complaint, selecting from options such as mail or personal pickup.
11. Once all sections are filled, review your form for any errors or omissions. Save your changes, and when you are ready, download or print the completed form for submission.

Complete your Death Certificate Complaint Form online today to ensure your concerns are addressed promptly.