Health Care Unit Complaint Form You may submit a health care complaint using the form below, or by calling (401) 274-4400 x1896. While the Rhode Island Office of the Attorney General may open investigations or brings lawsuits to enforce laws in the general public interest, the Attorney General does not represent individual consumers. We cannot provide you with legal advice or act as your attorney. If you have concerns concerning your individual legal rights or responsibilities, you should contact a private attorney. Completing this form is the first step in determining whether this Office can provide assistance; it does not necessarily mean that this Office will initiate legal action. If the complaint falls with the jurisdiction of another local, state or federal agency, we will provide you with the appropriate referral information. The information you provide may be forwarded to the appropriate law enforcement or administrative agency at the discretion of this Office to assist in the investigation of your complaint. Under Rhode Island’s Access to Public Records Act (APRA), your complaint and any associated correspondence and documentation may be considered a public record. As such, it may be made available to a member of the public who makes a public records request to our Office. Exceptions to the APRA include “all records relating…to a doctor/patient relationship, including all medical information relating to an individual in any files.” More information about Rhode Island’s Access to Public Records Act is available here. 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Have you made a complaint to the person/entity? Yes No What was their response, if any? May we send a copy of this complaint to the person or entity you are complaining against? If your response is no, we may be prevented from taking action on your complaint. Yes No Do you have an attorney representing you in this matter? Yes No Is any legal action pending? Yes No Other… Enter other… Have you contacted any other state or federal agencies about this matter? Please describe. Please upload any accompanying documents. Relevant documents may include: bills, receipts, written denials, Explanations of Benefits, letters of medical necessity, or correspondence with business representatives (10MB limit). One file only.256 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. By submitting this form electronically, I certify that the information I have provided is true and correct to the best of my knowledge. 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