SAMPLE
LETTER OF COMPLAINT
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(insert) YOUR NAME
ADDRESS
TELEPHONE NUMBER
(insert)
CHIEF EXECUTIVE/COMPLAINTS MANAGER
NAME OF ORGANISATION
ADDRESS
(insert) DATE
Dear Sir/Madam
Re: (insert) PATIENT'S NAME,
DATE OF BIRTH, ADDRESS (if not yourself)
I am writing to you to complain
about the treatment at (insert) NAME OF PLACE WHERE
INCIDENT HAPPENED. (If you are complaining about a particular
member of staff, also include their name and position
if known).
(insert) DETAILS OF WHAT HAPPENED,
WHEN IT HAPPENED, AND WHERE IT HAPPENED. (Include names
and positions of people involved, if relevant. If the
events are very detailed list the main points in the
letter and enclose further background information on
separate sheets enclosed with the letter. Don't leave
out relevant information or any part of your complaint).
(Insert) DETAILS OF WHY YOU ARE
NOT SATISFIED. (If you wish to complain about a number
of matters, list the most important ones first. Try
to be clear and concise in the points you make).
(insert) SPECIFIC QUESTIONS YOU
WOULD LIKE ANSWERED. (List them in order of importance).
(insert) DETAILS OF WHAT RESULTS
YOU WANT FROM YOUR COMPLAINT. (These might include,
e.g. an apology, an explanation, action to put things
right, reassurance that the same thing will not happen
to someone else).
I would be pleased if you would
carry out a full investigation into my concerns and
provide a response in accordance with the NHS complaints
procedure.
A copy of this letter has been
sent to (insert) NAME AND ADDRESS OF HSSC. I should
be grateful if you would copy all letters regarding
this complaint to the Chief Officer at the HSSC. (Delete
this request if you do not wish the HSSC to be involved).
I look forward to receiving your
reply. Please do not hesitate to contact me if you need
any further information.
Yours faithfully,
(insert) YOUR SIGNATURE
(insert) YOUR NAME PRINTED
(If you are complaining on behalf
of someone else make sure you send a signed consent
form with your letter. A form for completion is enclosed
in this guide. If the patient is unable to consent,
e.g. if they are deceased, very ill or very young, then
consent is not needed).
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