HEALTH FACILITY COMPLAINT FORM
Complete the information on all sections of this form. If you need help or have questions about this form, please call 800-882-6006.
Note: If you wish to remain anonymous, skip to Section 2 - RESIDENT/PATIENT INFORMATION section. If anonymous, our office will not be able to contact you to obtain additional information or reach you to notify you of the results of the investigation.
All Health Care Facilities that are state licensed and/or federally certified providers are required to post the name, title, location, and telephone number of staff responsible for receiving complaints. You may wish to contact the provider representative or administrator before filing this complaint.
The Department will send an acknowledgement letter upon receipt of the complaint and will send an additional letter after the investigation is completed to notify the complainant regarding the results of the investigation.
Other agencies that help citizens with complaints are:
The State Long Term Care Ombudsman
The long term care ombudsman program can help you file a complaint or investigate your concerns at licensed long-term care facilities.
Call: 866-485-9393 (toll-free)
Department of Attorney General (AG)
The AG investigates elder abuse and Medicaid fraud.
Fax: 517-241-6515 or 517-241-1029
Mail: P.O. Box 30218, Lansing, MI 48909
Michigan Protection & Advocacy Service (MPAS)
MPAS can help you file a complaint or investigate an abuse/neglect allegation.
LARA Bureau of Professional Licensing - Licensed Health Professionals
The Bureau also handles complaints against licensed health professionals including physicians, nurses, etc.
Children and Adult Licensing
The Bureau handles complaints against a state licensed adult foster care, home for the aged, child care center or home, or adult foster care or child camp.
The Department of Licensing and Regulatory Affairs will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability or political beliefs. If you need assistance with reading, writing, hearing, etc. under the Americans with Disability Act, you may make your needs known to this agency.