Nursing Home Complaint Form Template
Form Template
Anyone with knowledge or concerns about the care of a resident in a nursing home may file a complaint with their State Survey Agency.
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The State Survey Agency is the agency that has regulatory responsibility for all the nursing homes in the state. You may use the Nursing Home Complaint Form Template mobile app to file a complaint if you are concerned about the health care, treatment, or services that you or another person received or did not receive in the nursing home. Some reasons for filing a complaint would be abuse, neglect, poor care, not enough staff, unsafe or unsanitary conditions, dietary problems, or mistreatment.
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