Complaints Process - Instructions

This complaint form may only be used to file a complaint against an MD. If you wish to file a complaint against a health provider other than an MD, please check here for a list of other licensing agencies; find the type of health care provider you wish to file a complaint against and; contact the corresponding licensing agency.
1. Complete the enclosed complaint form, treatment information form and medical records release form.
2. Provide the full name of the MD that you wish to file a complaint against. You may name more than one doctor per complaint.
3. Complete a detailed narrative statement outlining your complaint in chronological order.
4. Provide the names of all other health care providers who have evaluated or treated the patient for the same medical condition, either before or after the subject physician, including physicians, hospitals and emergency rooms, urgent case centers and radiology (x-ray) facilities.  Please provide the dates of treatment for each health care provider.
5. Provide the full name, address and daytime telephone number of any witnesses that can provide evidence to support your complaint, as well as, a brief statement about what evidence the witness is able to provide.
6. Provide a copy of any supporting documents you have in your possession pertaining to your specific complaint, i.e., copies of medical records, explanation of Medicare Benefits (EOMB) or other insurance payments, billings, correspondence, etc.  Please do not provide the Board with your original documents.
Please be advised, the Board's complaint files and records are confidential investigative materials, and by law, and are not available to you. Arizona Revised Statutes (A.R.S.) 32-1451.01.  Ensure you have all of your complaint information available prior to the commencement of completing your complaint.  Complete and submit your complaint in one session.  Currently we do not support the on-line capability to retrieve and edit a complaint once it has been submitted.
 
Next Steps:
Click here to download/print a blank Complaint form; or

Click here to file a Complaint on-line.


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