Recipient Rights Forms

Complaint Forms

If you think that your rights have been violated, you or someone on your behalf may file a complaint with the Office of Recipient Rights. This may be done by mail, telephone, or in person. Forms on which to report alleged violations are also available at your service agency and Oakland Community Health Network (OCHN). If you need assistance, please contact Customer Services at 800-341-2003.

Access Complaint Forms:

• Arabic Complaint Form (PDF)
• English Complaint Form (PDF)
• Spanish Complaint Form (PDF)

Authorization to Disclose Employee Information

The Authorization to Disclose Employee Information and Release of Liability form enables you to verify whether employees that you have hired or are now considering for hire have any record of rights violations.

• Disclosure/Release of Liability (PDF)
• Incident Report (PDF)