Report Patient Abuse or Neglect

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Report Patient Abuse and Neglect

The details you provide will help in the investigation and potential prosecution of your allegation. Please provide as much information as possible The nature of your complaint and the fact that you filed it will not be shared with the person or agency named in your complaint.

Your Information

* First name:
Middle name:
* Last name:
E-mail:
Phone number:	() -

Provider or Person Committing Abuse Information

* Name:
Address 1:
Address 2:
City:
State:
ZIP code:

Other Information

Victim's name:
Occurrence date:
* Specific details:
Do you have additional documents or information:	Yes

* Required

Ohio Attorney General Richard Cordray

Ohio Attorney General Richard Cordray

Report Patient Abuse and Neglect

Your Information

Provider or Person Committing Abuse Information

Other Information

What is patient abuse or neglect?

Questions?

Please send any additional documentation to: