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DLRS Home > Grievance Process Guide for Recipients of Mental Health Services > How to File a Grievance

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Grievance Process Guide for Recipients of Mental Health Services - How to File a Grievance

If you have been unable to resolve your grievance through your service provider, or you choose to take your grievance directly to the Department, your grievance must be documented on a DHHS Grievance Form, found on page 24 of this Guide and also available from all providers of mental health services to children and adolescents and at all DHHS offices. 

The Grievance Form asks you to provide the following information about the problem or issue you wish to grieve:

  • the name, address, phone number and date of birth of the child or adolescent recipient

  • the name, address, phone number and relationship to the child/adolescent of the person filing the grievance

  • the name, address, and phone number of the provider/agency involved

  • the dates upon which the problem/issue which you are grieving took place

  • the names of all people involved

  • a description of what happened that has resulted in the filing of the grievance

  • the specific issue that needs to be addressed

  • your suggestions about possible ways to resolve the situation

If you need help in filling out the Grievance Form, your provider or a representative from DHHS is also available to assist you.

Send the fully completed Grievance Form to the designated DHHS Grievance Coordinator listed at the bottom of the form, making sure to indicate grievance on the lower left corner of the envelope.