Medical Complaint Form Guide
Appear reasonable and respectful. Don't whine.
Some forms use half the page to identify the parties. Instead put that in a few lines at the top. A one-page (if possible) summary laid out as below can help it move through the system.
Your Name, Street Address, City, State, Zip
Home and Work Phone
Patient's Name, Social Security Number and Date of Birth
Your relationship to patient
Full Name, Address and Phone of provider being reported
Date and location the incident occurred
Some states want you to include here the identities of other practitioners involved in relevant treatment, but that can be a long list and probably either should be attached or included along with the objective data.
If you are merely jotting a note expressing your concerns, then that's all that there is left for you to do. If you are going to get more involved than that, then this page will be only a summary of attached pages that are more in depth. In that case write the two paragraphs below.
Paragraph summarizing the Objective Data (see below).
Paragraph summarizing the Subjective Data (see below).
Usually, the actual data should be attached as well (for instance).
If there were any witnesses, you are supposed to identify who they are, although it is rare for healthcare professionals to testify for patients no matter what happened. They are a team who work with and depend on each other everyday. Turning on a colleague can ruin their careers. They stick up for each and testify against you (see loyalty).
Some states want you to tell them if you have filed complaints about the same incident with anyone else. They want to make sure that they are not duplicating work being done by someone else. They will call the other agency and accept whatever conclusions they have reached.
Sign and date your complaint.
Visible, palpable or measurable things like x-rays, ultrasound, pulse rate, temperature. And the notes of medical professionals to interpret all of that. Especially any incident report that might have been filed, although it is unlikely you'd be able to find out if one existed.
Unfortunately, all of that objective data does nothing more than show what the damage is. It does not necessarily connect the damage to the person who caused it. Almost nothing does.
However, paper trails are difficult to ignore. Most injuries do not create a paper trail, and even if they should have, medical personnel are trained in the art defensive documentation to prevent it. They don't record information that incriminates themselves or other medical personnel (see loyalty and white wall of silence). But sometimes one exists. If you find one, you not only have to obtain it, but digest it and present it in a form that any secretary could understand.
Medical boards will tell you that they will take care of all of that for you. Don't count on it.
Pain, sensory problems, discomfort, tenderness or weakness, while important to note, carry little weight. Your own testimony about what occurred also is subjective and carries almost no weight, but must be noted.
All in all, the odds of anything resulting from your complaint are slim. If anything does, it will be because you did the investigation, gathered the documents and presented the results lucidly and tactfully, and perhaps with diagrams or even graphs if appropriate.
An adage repeated in some circles of law is that you have to "take" justice.
All of this is time consuming and often confusing. To add to the obstacles, you need to know what is written about you in the records. Boards don't believe what you say. They believe what doctors write down. You need to know what they wrote about you. Look at your records. When you quote what a doctor told you, but that is contradicted by what the doctor wrote in the record, you lose. It is necessary to know where these problems are in order to figure out how to address them. The boards will not get to the bottom of it. You have to.