Authorization Number : 440-0289
Agency Series No. : 11-04
Status : Active
Agency Web Link :
Agency : DOH
Confidential Description : N/A-Load
Division : DOH3013
Vital Description :
Section :
Record Title : Health Facilties Complaint Forms
Revision : 1
Record Description : Includes any provider/facility complaint forms such as Complaint Unit Intake Form, Medicare/Medicaid Complaint Form, ODH Summary of Complaint Form, and Long Term Care Quality Assurance Forms. May contain confidential complaint or patient information.