Welcome to the LTC Administrator Complaint Registry

REPORT AN ADMINISTRATOR ONLINE

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Information identifying the Long Term Care Administrator against whom the report is being filed:

Indicates Required Fields

Last Name:

First Name:

Name of Facility:

City:

Nature of Your Report (be as specific as possible, including names, dates, etc., and cite the rule number(s) from OAC 490:10-5-3(a) that you believe the administrator most likely violated):

Information identifying the individual filing the report: (NOTE: The Board cannot accept or process 'anonymous' reports. If the information requested below is not furnished, the Board cannot and will not proceed.)

Last Name:

First Name:

Phone: e.g., (555-222-1111)

Street:

City:

State:

Zip:

Email Address: