Rights Complaint Form

Nurses, doctors, and case managers working together to help me with resources and working strongly to help me overcome the loss of my marriage

-Osceola County

Online Recipient Rights Complaint Form
Complainant's Name*
Recipient's Name (if different from complainant)
Phone Number*
Address
Where did the alleged violation happen?*
When did it happen?* (Date and time)
What right was violated?
Describe what happened*
What do you want to have happen in order to correct the problem?*

*Denotes required information. CMHCM will not sell, disseminate, disclose, trade, transmit, transfer, share, lease or rent any personally identifiable information to any third party not specifically authorized by you to receive your information.

Nurses, doctors, and case managers working together to help me with resources and working strongly to help me overcome the loss of my marriage

-Osceola County

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