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Sample Letter Of Complaint (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). Southern Health and Social Services
Council, Quaker Buildings, High Street, Lurgan, Co. Armagh, BT66
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