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Complaint Intake Form

 
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Health Facilities Licensing & Certification (HFLC) is responsible for processing complaints for the health care facilities we oversee. A list of the facilities we currently oversee can be found below. If you are unable to locate the facility you are looking for on the list below, we are not responsible for its oversight and should not receive any information regarding that facility.  
 

 
**The Assisted Living Licensing webpage has more information about the Residential Assisted Living Home complaint process.
 

Instructions for Completing the Intake Form

  1. Click on the Complaint Intake Form link (below) which will direct you to a fillable PDF form.
  2. Complete the form online or save a copy to your computer and use it as needed.
    *Please note, if you complete the form online, there is no copy so once you leave that page, the information is deleted and you will have to fill it out again.
  3. When completing the form, be as thoroughly as possible and attach additional pages as needed if you need additional room.
  4. Print the form, and any additional pages, and submit it to our office using the information provided below.

 
Submit completed complaint intakes to Health Facilities Licensing & Certification by:

Secure Fax: (907) 334-2682

By Secure Email (ONLY if you have an existing Direct Secure Messaging (DSM) account): DHCS.HFLC@hss.soa.directak.net

*Please Note, sending this information by any email, other than the DSM, is NOT SECURE.

By mail or in person to:
Health Facilities Licensing & Certification
Attn: Complaint Coordinator
4501 Business Park Blvd. St. 24, Bldg. L
Anchorage, AK 99503

If you have any questions about this complaint form or how to submit it, please contact our office at (907) 334-2483.
 
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Frequently Asked Questions


1. What happens after I submit a complaint?

The information provided will be carefully reviewed against the applicable Alaska Administrative Rules and/or Code of Federal Regulations for the specific facility or agency type this complaint is about. The review will determine if there are potential violations of those requirements and if this is the office with jurisdiction to take further action. You will be notified in writing of the results of the review. The letter will inform you what action this office has authority to take, which may include an unannounced, onsite investigation. If it is determined that the concerns fall under the jurisdiction of another agency or organization the letter will provide you with that information.

 
2. Is my personal and complaint information kept confidential?
Your identity as the complainant is maintained confidentially. This office is prohibited from releasing complainant information and the complaint systems are designed to protect that anonymity.
 
3. If an investigation is completed, how do I see the results?
The Statement of Deficiencies report and the provider's Plan of Correction regarding a complaint investigation will be available for public disclosure no later than 90 calendar days from the date of the investigation.