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STATE OF CONNECTICUT DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES A Healthcare Service AgencyCLIENT COMPLAINT AND GRIEVANCE FORM Submitted to Client Rights Officer or designee(2 pages) TO: Client

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How to fill out dmhas client complaint and

01

To fill out a DMHAS client complaint form, follow these steps:

02

Obtain a copy of the DMHAS client complaint form either online or from a DMHAS office.

03

Begin by entering the date of the complaint on the form.

04

Provide your personal information, including your name, address, phone number, and email address.

05

Identify the individual or entity you are filing the complaint against, and provide their contact information if available.

06

Clearly state the details of your complaint, including the specific incident and any supporting evidence you may have.

07

Explain the impact the alleged violation or mistreatment has had on you.

08

If applicable, provide the names and contact information of any witnesses or individuals who can validate your complaint.

09

Sign and date the complaint form to affirm the accuracy of the information provided.

10

Submit the completed complaint form to the appropriate DMHAS office or follow the instructions provided on how to submit the form electronically.

Who needs dmhas client complaint and?

01

Anyone who has received services from DMHAS (Department of Mental Health and Addiction Services) and wishes to file a formal complaint against a staff member, facility, service provider, or any aspect of their experience can make use of the DMHAS client complaint form.

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What is dmhas client complaint and?

dmhas client complaint is a formal grievance filed by a client of the Department of Mental Health and Addiction Services.

Who is required to file dmhas client complaint and?

Any client who feels that their rights have been violated or their needs have not been met.

How to fill out dmhas client complaint and?

The complaint can be filled out online, by mail, or in person at a DMHAS facility.

What is the purpose of dmhas client complaint and?

The purpose is to address grievances and improve services provided by DMHAS.

What information must be reported on dmhas client complaint and?

The client's name, contact information, date of complaint, description of grievance, and desired outcome.

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