Patient Care Quality Complaints

Make a Complaint

Request a Review

Review Process

Online Review Request

The Patient Care Quality Review Boards have legal authority to review a care quality complaint that has been addressed by a health authority's Patient Care Quality Office but remains unresolved. If you have not submitted this complaint to with a Patient Care Quality Office, you complete that process before submitting a review request form. For more information, please visit www.patientcarequalityreviewboard.ca

If you need assistance completing this form, please call 1 866 952-2448.

If you have any other supporting documents that you wish to include with this submission, please do so by clicking on the "browse" button and locating the file on your computer.

AUTHORIZATION*

The personal information requested on this form and any additional information required by a Patient Care Quality Review Board in reviewing the care quality complaint submitted by or on behalf of an individual is collected under the authority of the Patient Care Quality Review Board Act and the Freedom of Information and Protection of Privacy Act, and will be used only for the purpose of reviewing this complaint. All persons obtaining personal information under the Patient Care Quality Review Board Act are under a duty of confidentiality with respect to that information. If you have any questions about the collection, use or disclosure of this information please contact the Patient Care Quality Review Board Secretariat at the telephone number, fax number or mailing address set out at the bottom of this form. The authorization you complete below becomes effective on the date this form is submitted and remains in effect until the review is completed.

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HLTH 9040 Last Revised: May 07, 2014