This form is a sample complaint for use in a personal injury case involving the injury of the plaintiff due to a gunshot wound inflicted by the defendant.
Vermont Complaint regarding Gunshot Injury
State:
Multi-State
Control #:
US-PI-0264
Format:
Word;
Rich Text
Instant download
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Public form
Description
How to fill out Complaint Regarding Gunshot Injury?
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FAQ
Vermont is a compact state. If you hold a multistate license in another state, you are able to practice in Vermont under your multistate license and you do not need take any additional steps to practice in Vermont.
If you have any questions, contact the Board: (802) 657-4223.
There are four ways in which you can make a complaint: By Email: AHS.DAILSCIntake@vermont.gov **Preferred Method** By FAX: 1-802-241-0383. Call Toll Free: 1-888-700-5330. When filing a complaint via telephone, please be prepared to: ... By US Mail: Survey & Certification Complaint Intake.
Mail Address: Vermont Board of Medical Practice, 108 Cherry Street, P.O. Box 70, Burlington, VT 05402. To proceed with an investigation, the complaint form and Authorization for Release of Medical Records must be received by the Board. Call (802) 657-4220 with questions.
Contact Us Division of Licensing and Protection. Adult Protective Services Reporting Line. (800) 564-1612. Healthcare Organization Complaint Reporting Line. (888) 700-5330. Joe Nusbaum. Division Director. John Gordon. Adult Protective Services Director. Suzanne Leavitt. Survey and Certification Director.