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Health Facilities Consumer Resident/Patient Complaint Report - Department of Health (New Jersey) Mobile App

Now you can be sure that each time you lodge a complaint, it instantly reaches the concerned person by using this digital application. Patients, health care facility employees and other members of the public may file complaints in real time about hospitals, home health agencies, nursing homes, assisted living facilities etc. Quickly add details, select type of complaint, acknowledge information and sign off in the app.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Health Facilities Consumer Resident/Patient Complaint Report - Department of Health (New Jersey) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Today's Date

  • Ico date

    Date of Event

  • Ico time

    Time of Event

  • Ico checkbox

    AM

  • Ico checkbox

    PM

  • Ico statictext

    This form can be used to report complaints pertaining only to the facility types listed below, wh...

  • Ico statictext

    Select Facility Type

  • Ico checkbox

    Nursing Home

  • Ico checkbox

    Residential Facility

  • Ico checkbox

    Sub-Acute Care Facility

  • Ico checkbox

    Assisted Living or Comprehensive Personal Care Home

  • Ico checkbox

    Assisted Living Program

  • Ico checkbox

    Intermediate Care Facility for the Mentally Retarded

  • Ico checkbox

    Adult/Pediatric Day Health Services

  • Ico checkbox

    Hospital

  • Ico checkbox

    Ambulatory Surgical Center

  • Ico checkbox

    Other Ambulatory Care Facility

  • Ico textbox

    Specify

  • Ico textbox

    Full Name of Facility

  • Ico multiline

    Address

  • Ico textbox

    Facility Telephone Number

  • Ico textbox

    Name of Person Reporting

  • Ico textbox

    Home Telephone Number

  • Ico textbox

    Work Telephone Number

  • Ico textbox

    Cell Phone Number

  • Ico statictext

    Relationship

  • Ico checkbox

    Family Member

  • Ico checkbox

    Employee

  • ...and More!

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