Client Rights - DHS 94 Grievance Procedure Model

The Clients Rights Office has developed a model grievance procedure for new service providers who do not yet have a process in place. It can also be used by existing providers who wish to update their current procedure.

This model grievance procedure can be adapted to the service provider's needs. The service provider can insert the provider's name in the model policy or otherwise adapt it as needed.

Sample decision formats

The Client Rights Office has developed sample decision formats for use in the grievance process.

  • Sample Level I-A Report by the Client Rights Specialist (Word (15 KB) or PDF (13 KB)
  • Sample Level I-B Decision by the Program Manager (Word (16 KB) or PDF (18 KB)
  • Sample Level II Decision by the County Director (Word (16 KB) or PDF (17 KB))
Last Revised: June 1, 2016