Grievance
Every resident has a right to nondiscrimination, a right to fair housing, a right to file a grievance in accordance with program procedures and a right to a statement of financial accounting including receipt for payment. Any grievance not addressed by immediate staff in a satisfactory manner may be submitted here for review by management and ultimately escalated to the appropriate governing authority up to and including the NCARR
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Resident Name:
Date:
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DD
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YYYY
Description of Issue or Injury:
Previous Steps Taken by Resident to Resolve the Issue:
What Steps Have Been Taken by Staff to Address Your Incident or Concerns?
What Would You Like to See Accomplished at This Point to Address Your Injury or Grievance?
Would You Like Our Assistance in Appealing Your Issue to the Appropriate Medical or Oversight Authority?
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If A Compromise is Unreachable Would You Like Our Assistance to Relocate to another Housing Option or Healthcare Facility?
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A copy of your responses will be emailed to the address you provided.
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