Doh 3867-2026

1. Click ‘Get Form’ to open the doh 3867 in the editor.
2. Begin by filling out the 'INFORMATION ABOUT YOU' section. Enter your name, address, and telephone numbers clearly. Ensure all fields are completed for accurate processing.
3. Next, provide details regarding the physician or physician assistant you are filing a complaint against in the 'YOUR COMPLAINT REGARDING A PHYSICIAN OR PHYSICIAN ASSISTANT' section. Include their full name and contact information.
4. In the 'INFORMATION ABOUT THE PATIENT(S)' section, list any patients involved along with their date of birth. You can add more names on a separate sheet if necessary.
5. Describe your complaint thoroughly in the 'DETAILS OF YOUR COMPLAINT' section. Be specific about when and where the incident occurred, and mention any witnesses.
6. Finally, sign and date the form at the bottom before submitting it. Remember that your original signature is required for processing.

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