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Welcome to the LTC Administrator Complaint Registry


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

AsterikIndicates Required Fields

Asterik Last Name:
Asterik First Name:
Asterik Name of Facility:
Asterik City:

Asterik 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):

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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.)
Asterik Last Name:
Asterik First Name:
Asterik Phone:
e.g., (555-222-1111)
Asterik Street:
Asterik City:
Asterik State:
Asterik Zip:
Asterik Email Address:

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