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Nys professional discipline complaint form 2012-2025

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The document is a Professional Discipline Complaint Form that provides instructions for individuals to file complaints against licensed professionals or unlicensed practitioners regarding service issues or illegal practices. It outlines the necessary steps to complete the form, including providing personal information, detailing the complaint, and authorizing the release of treatment information. The document also specifies where to send the complaint based on the type of professional involved and emphasizes that certain disputes, such as fee disagreements, are not within their investigative authority.

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Click ‘Get Form’ to open the NYS Professional Discipline Complaint Form 2012 in the editor.
Begin by filling out the 'Information About You' section. Enter your name, address, city, state, zip code, county, and daytime and evening telephone numbers. Ensure all details are accurate for effective communication.
In the 'Information on the Person(s) You Are Complaining About' section, provide the name(s), profession, and contact information of the individual or entity you are filing a complaint against.
Describe your complaint in detail. Be specific about what happened, when it occurred, and where it took place. Use black ink if you are printing or type directly into the fields provided.
Sign and date your complaint at the bottom of the form. If you have additional sheets or supporting documents, check the box indicating their inclusion.
Complete the Authorization section by entering your name and that of the practitioner or facility involved. Sign this section as well as having a witness sign it.
Once completed, submit your form to the appropriate regional office listed on the document to ensure timely processing of your complaint.

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Versions	Form popularity	Fillable & printable
2022	4.7 Satisfied (32 Votes)
2020	4.8 Satisfied (148 Votes)
2013	4.3 Satisfied (139 Votes)
2012	4 Satisfied (60 Votes)

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How do I complain about a professional license in NY?

For information on filing a complaint call 1-800-442-8106 or email conduct@nysed.gov . Please note, complaints must be submitted in writing and cannot be filed by phone. See instructions below. You may also wish to see a description of New Yorks professional discipline system.

What happens when you file a complaint against a doctor in New York?

Potential results of filing a complaint When the committee finds misconduct, the board holds a disciplinary hearing. The board can revoke or suspend a physicians license to practice medicine, limit the practice, censure or reprimand, order education or training, levy a fine or require community service.

How to file a complaint against a teacher in NY?

Contact: the principal, Respect for All Liaison or any staff member at your school. Use Find a School to get the Respect for All Liaison at your childs school. Submit the Complaint Reporting Form , to the principal, the Respect for All Liaison or any staff member at your school.

What is professional misconduct in NYS?

Professional misconduct includes the following: Engaging in acts of gross incompetence or gross negligence on a single occasion, or negligence or incompetence on more than one occasion. Permitting or aiding an unlicensed person to perform activities requiring a license.