The Division of Licensing Services Office of Long Term Care Licensing provides this Online Complaint Form which allows anyone with knowledge or concerns about a suspected violation to submit a complaint through this web page.  A complaint is a suspected violation of Arizona state rules and/or statutes or federal rules governing the operations of licensed Long Term Care Nursing Homes and Intermediate Care Facilities for Developmentally Disabled (ICFMR).

Complaint Frequently Asked Questions (FAQs)

When filling out this form, information that is required is indicated by a red asterisk ( ).





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Submitting a complaint

If you are making a complaint, state law at A.R.S.§41-1010 requires that the name of the complainant shall be a public record unless the affected agency determines that the release of the complainant’s name may result in substantial harm to any person or to the public health or safety. If you have any reason to believe that substantial harm will result to you, someone else, or the public from your disclosure, please notify the Department immediately.


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Please provide the Arizona Department of Health Services with a phone number where you can be reached in case more information is needed.



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This facility is not licensed by the Arizona Department of Health Services and is regulated by the Federal Government. Complaints regarding this facility should be directed to the Center for Medicare and Medicaid Services (CMS) at the Region IX Regional Office in San Francisco. The number is: (415) 744-3679.


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