N.H. Admin. Code § Omb 403.02 - Complaint Intake Information

(a) During the complaint intake process the OLTCO shall request the following information:

(1) The complainant's identifying information, including:

a.The name of the complainant or the entity; and

b.The address and telephone number of the complainant or the entity;

(2) The resident's identifying information, including:

a.The resident's name;

b.The resident's date of birth; and

c.The resident's address, including room number or current location if known;

(3) The name and contact information for the resident's legal representative, or personal patient representative, if applicable; and

(4) Informed consent if the complainant or resident wishes to provide informed consent.

(5) Information related to the complaint(s) including but not limited to:

a.The date and time that the incident or the subject of the complaint occurred;

b.A description of what occurred;

c.If the complaint is being made by a healthcare facility representative, the name of the person who originally made the report to the facility;

d.Contact information for any staff member involved in the incident or situation described by the complaint; and

e.Any action the facility has taken or plans to take to respond to the incident or situation described by the complaint.

(b) When a complaint is received, the LTCO or LTCOR shall open a case.

Notes

N.H. Admin. Code § Omb 403.02

Derived From Volume XXXVII Number 41, Filed October 12, 2017, Proposed by #12379, Effective 9/13/2017, Expires 9/13/2027.