Illinois Complaint for Medical Malpractice regarding Diagnosis and Treatment

State:
Multi-State
Control #:
US-CMP-10041
Format:
Word; 
Rich Text
Instant download

Description

This is a model Complaint for damages caused by the negligence of a medical provider whose staff physician negligently failed to diagnose a common medical condition, resulting in severe mental and physical pain and unnecessary medical treatment, tests and associated expense over a period of months. The problem was later properly diagnosed and treated by a second provider. Damages are sought from the first provider. Adapt to fit the circumstances of your case. Care must be used to comply with the law and court rules for your state, because this is a model form.
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FAQ

If you have questions or need assistance, please contact the Illinois Department of Public Health (IDPH), Division of Environmental Health, at 217-782-5830 or send an e-mail. You also may contact a regional office. Use the map below to find contact information for the regional office that serves your community.

For non-long term care complaints contact the Department's Division of Health Care Facilities and Programs at 217-782-7412. To make inquiries, you must have the name and location of the facility. This is not a toll-free call.

You may also write the Department of Human Services (IDHS) at Department of Human Services, Bureau of Civil Affairs, 401 South Clinton St., 6th Floor, Chicago, Illinois, 60607 or call the IDHS Helpline Number at 1-800-843-6154 or 866-324-5553 TTY/Nextalk or 711 Relay.

COMPLAINT FORM COMPLAINT FORM. Illinois Department of Public Health. Office of Health Care Regulation. Central Complaint Registry. 525 W. Jefferson St., Ground Floor. ... Central Complaint Registry Hotline - 800-252-4343. Monday-Friday a.m. to p.m. ... State of Illinois. Illinois Department of Public Health. Page 2.

Department's complaint form, contact our office toll-free at (877) 527-9431. When your complaint is received, a file number will be assigned and you will be sent written notification of that number.

Central Complaint Registry Hotline - 800-252-4343. Monday-Friday a.m. to p.m. TTY for the Hearing Impaired Only- 800-547-0466.

Who should I contact to check the status of my complaint? To check the status of a long-term care complaint, contact the Department's Bureau of Long-Term Care at 800-252-4343. For non-long term care complaints contact the Department's Division of Health Care Facilities and Programs at 217-782-7412.

If you have questions or need assistance, please contact the Illinois Department of Public Health (IDPH), Division of Environmental Health, at 217-782-5830 or send an e-mail. You also may contact a regional office. Use the map below to find contact information for the regional office that serves your community.

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Illinois Complaint for Medical Malpractice regarding Diagnosis and Treatment