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Welcome to the LTC Administrator Complaint Registry



REPORT AN ADMINISTRATOR ONLINE

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:

Please enter the confirmation key below.

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The number for position 1 is: two plus one
The number for position 2 is: eight plus zero
The number for position 3 is: eight minus seven
The number for position 4 is: two plus two
The number for position 5 is: two plus two

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