Complaint Form - Illinois Department Of Public Health (Page 3 of 4) in pdf

Complaint Form - Illinois Department Of Public Health Page 3

State of Illinois

Illinois Department of Public Health

Office of Health Care Regulation

Division of Health Care Facilities and Programs

Bureau of Long Term Care

Complaint Investigations

Frequently Asked Questions

The Department investigates quality of care issues, such as allegations of actual or potential harm to patients,

patient rights, infection control, and medication errors. The Department also investigates allegations or harm or

potential harm due to an unsafe environment.

Q. What information is needed to file a complaint?

The Department needs to know the who, what, when, where and how.

Who is the patient/resident? Who are the employees involved?

What happened to the patient/resident? What are the specific allegations (abuse/neglect, acquired in-

fections or medication error)?

When did this incident occur (date of incident, admission or treatment)?

Where is the facility located (name and city)? Where in the facility did the incident occur (room number,

unit, or department)?

How was the patient harmed? How could the patient have been potentially harmed?

How was your complaint addressed by the facility?

Q. Who may file a complaint?

Complaints may be filed by, but are not limited to, patients, patient family members, care givers, staff or

advocacy groups.

Q. Is the identity of the complainant disclosed?

The identity of the complainant is not disclosed to the facility by the Department. The complainant may

provide a name, address and phone number to the Department. This information is required if the

complainant would like to receive written notification of receipt of the complaint and notification of the

outcome of the complaint investigation. Complaints may be filed anonymously.

Q. What happens after a complaint is filed? When will my complaint be investigated?

All complaints are logged and reviewed. Complaints are investigated on a priority basis. Depending on

the nature, scope, and severity of the complaint allegations, the investigation may take from a few days

or weeks, to several months.

Complaint Form - Illinois Department Of Public Health Page 3