The Client Rights Office created a format that providers can use during the grievance process. This applies to adults and children—or someone on their behalf—who are receiving services for mental health, developmental disability, or substance use and are filing a rights complaint.
- Wis. Admin. Code ch. DHS 94—Patient Rights and Resolution of Patient Grievances (PDF)
- Community Grievance Resolution Procedure—Process Flow Chart (PDF)
New providers who don’t yet have a process in place can use this sample. Existing providers who want to update their process may find it helpful, too. Providers can change it to fit their needs. For example, you can add your own name.
We’ve also created sample forms you can use during the grievance process:
- Sample Level 1-A Report by the Client Rights Specialist (Word)
- Sample Level 1-B Decision by the Program Manager (Word)
- Sample Level II Decision by the County Director ((Word)