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Alabama Department of Public Health
Bureau of Health Provider Standards
Nursing Home Complaint Form

Instructions for Filing a Nursing Home Complaint

1. Please include as much information as possible when submitting your complaint. The response and timing of any investigation by the State Survey Agency will be based upon the information you provide.

Reporting a concern as soon as possible will make it easier for you to remember the facts, and it will assist the State Survey Agency in gathering important information.

You can remain anonymous.

The State Survey Agency representative will not use your name while investigating the complaint. If you wish to know the results of the investigation, please include your name, address, and contact information on the complaint form.

2. Following the receipt of your complaint, a representative from the State Survey Agency will contact you about your concerns and discuss the appropriate course of action and anticipated timeframes. The representative will also provide you with the telephone number of a contact person at the State Survey Agency for further follow-up.

3. If your concern involves a possible violation of a Federal or State nursing home regulation, the State Survey Agency will take appropriate action. The investigation may include a review of records, interviews with staff and residents, and the observation of resident care.

If your concern does not fall under the jurisdiction of the State Survey Agency, your concern will be referred to the appropriate agency.

4. At the end of the investigation, the State Survey Agency will notify you of the results if you provide your contact information in Section 1 on the complaint form.


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