Client Rights: DHS 94 Grievance Procedure Model

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.

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.

Client Rights Grievance Resolution Procedure Model (Word)

We’ve also created sample forms you can use during the grievance process:

Learn more about the process for filing a complaint

Last Revised: July 2, 2022