Filing a Complaint
Filing a Complaint
Options for Filing a Complaint
You have two options when filing a complaint. Use our online system or download a complaint form. If you choose to download a form, you will need to fax, email or mail the completed form to our office.
- Please complete the entire form.
- Provide the name of the DO against whom you are filing a complaint. You may name more than one DO per complaint.
- Complete a detailed narrative statement outlining your complaint in chronological order.
- Provide the names of all other health care providers who have evaluated or treated the patient for the same medical condition, if any.
- Provide the full name, address and phone number of any witness(es) who can provide evidence to support your complaint, as well as a brief statement about what evidence the witness is able to provide.
- Provide a copy of any supporting documents in your possession pertaining to your specific complaint, i.e., copies of medical records, explanation of Medicare Benefits (EOMB) or other insurance payments, billings, correspondence, etc. Please do not send the Board original documents as these cannot be returned to you.
The Board’s complaint files and records are confidential investigative materials and by law are not available to you pursuant to Arizona Revised Statutes (A.R.S.) § 32-1855.03. Please complete and submit your complaint in one session. Our online system will not allow you to retrieve and edit a complaint once it is submitted. To download a complaint form, click here.
Because the Health Insurance Portability and Accountability Act (HIPAA) is a federal law, not a state law, complaints alleging violations of HIPAA must be made directly to the U.S. Department of Health and Human Services’ Office of Civil Rights. The Board has no authority to investigate or act on these complaints.