The person filing the allegation must include:

• the name and profession of the licensee or registrant;
• a description of the alleged problem or incident, including dates and locations;
• as many details and records as possible to support your charge. Examples include medical records, hospital bills, or insurance claims; and,
• names and addresses and/or telephone numbers for anyone who can provide supporting information, including any subsequent health care providers, if appropriate.  

The name of the person filing the Allegation will be kept confidential unless he or she is required to testify at a hearing.