{"id":60,"date":"2025-02-25T17:07:08","date_gmt":"2025-02-25T17:07:08","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/complaintform\/"},"modified":"2025-02-25T17:07:08","modified_gmt":"2025-02-25T17:07:08","slug":"complaintform","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/complaintform\/","title":{"rendered":"complaintform ~ Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n  <br>\n\n\n  \n\n\n  <div class=\"container\" id=\"main_header\">\n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/ltcop\/complaintform.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1><!--[type=EDIT name=\"Page Title\"]--><!--[END]--><\/h1>\n\n\n    <\/header>\n\n\n   <\/div><br>\n\n\n \n\n\n  <div class=\"container\" id=\"main_content\">\n\n\n    <!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h1>Delaware Long-Term Care Ombudsman (LTCO) Complaint Form <\/h1><br>\n\n\n\n\n\n\n\n\n\n<p>In order to submit this online complaint, you must provide your name in the form below. If you want to file a complaint without providing your name, you can contact the LTCOP hotline at<strong> 1-855-773-1002<\/strong> and speak anonymously with an Ombudsman representative. <\/p>\n\n\n\n\n\n\n\n\n\n<p>If you are filing a complaint on behalf of an individual receiving Home and Community-Based Services, please contact the LTCOP hotline at<strong> 1-855-773-1002<\/strong> and speak with an Ombudsman representative. \n\n\n\n\n\n\n\n\n\n<\/p><p>This form can be used to report complaints pertaining only to the facility types listed below, which are under the jurisdiction of the LTCO Program. If you are unsure of the facility type, please select Other. <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<form action=\"https:\/\/smug.dti.delaware.gov\/smu\/mailer\" id=\"LTCO\" method=\"post\" name=\"LTCO\">\n\n\n\n\n\n\n\n\n\n<div class=\"row\">\n\n\n\n\n\n\n\n\n\n         <div><label for=\"Name\">Name of Facility<\/label><\/div>\n\n\n\n\n\n\n\n\n\n  <div><input id=\"Name\" name=\"Name\" size=\"40\" type=\"text\"><\/div> \n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"stradr\">Street Address<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"stradr\" name=\"stradr\" size=\"40\" type=\"text\">\n\n\n\n\n\n\n\n\n\n <\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"city\">City<\/label><br>\n\n\n\n\n\n\n\n\n\n <input id=\"city\" name=\"city\" size=\"40\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"zip\">Zip<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"zip\" name=\"zip\" size=\"20\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n<div>\n\n\n\n\n\n\n\n\n\n  <label for=\"anonymous\">Do you wish to remain anonymous to the facility (Yes or No)?<\/label><\/div>\n\n\n\n\n\n\n\n\n\n  <div><input id=\"anonymous\" name=\"anonymous\" type=\"text\">\n\n\n\n\n\n\n\n\n\n <\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n <div><label for=\"personrepot\">Name of Person Reporting:<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"personrepot\" name=\"personrepot\" size=\"40\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"emladr\">Your Email Address<\/label><\/div>\n\n\n\n\n\n\n\n\n\n   <div><input id=\"em\" name=\"em\" placeholder=\"Ex: You@domain.com\" required size=\"40\">\n\n\n\n\n\n\n\n\n\n <\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"number\">Contact Number:<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"number\" name=\"number\" size=\"40\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n<div>\n\n\n\n\n\n\n\n\n\n  <label for=\"relationship\">Relationship to Resident: <\/label><\/div>\n\n\n\n\n\n\n\n\n\n  <div><input id=\"relationship\" name=\"relationship\" size=\"40\" type=\"text\">\n\n\n\n\n\n\n\n\n\n <\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n <div><label for=\"residname\">Resident&#8217;s Name:<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"residname\" name=\"residname\" size=\"40\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n        <div><label for=\"dob\">Date of Birth<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"dob\" name=\"dob\" size=\"20\" type=\"text\"><\/div>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n        <div><label for=\"contnum\">Contact Number<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><input id=\"contnum\" name=\"contnum\" size=\"40\" type=\"text\"><\/div><br>\n\n\n\n\n\n\n\n\n\n<div>\n\n\n\n\n\n\n\n\n\n  <label for=\"roomnumb\">Room Number <\/label><\/div>\n\n\n\n\n\n\n\n\n\n  <div><input id=\"roomnumb\" name=\"roomnumb\" size=\"20\" type=\"text\">\n\n\n\n\n\n\n\n\n\n <\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<br><br>\n\n\n\n\n\n\n\n\n\n <div><label for=\"descript\">Describe the event: Provide a detailed description of the complaint.<\/label><\/div>\n\n\n\n\n\n\n\n\n\n <div><textarea cols=\"50\" id=\"descript\" name=\"descript\" rows=\"5\"><\/textarea><\/div>\n\n\n\n\n\n\n\n\n\n<p>Once your complaint is received, it will be reviewed by an Ombudsman representative. If you have provided a contact number, you may receive a call from the designated Ombudsman seeking additional information to resolve your complaint. <\/p>\n\n\n\n\n\n\n\n\n\n <!-- Do not remove or alter this section -->\n\n\n\n\n\n\n\n\n\n <div id=\"submit_buttons\">\n\n\n\n\n\n\n\n\n\n      <input class=\"hidden\" id=\"address\" name=\"address\" type=\"text\" value=\"\">\n\n\n\n\n\n\n\n\n\n      <input class=\"hidden\" id=\"subject\" name=\"subject\" type=\"text\" value=\"\">\n\n\n\n\n\n\n\n\n\n     <input class=\"hidden\" id=\"AGENCYUID\" name=\"AGENCYUID\" type=\"text\" value=\"cb161188-ce6e-4d9f-b2da-66eda86c5e3e\">\n\n\n\n\n\n\n\n\n\n     <input class=\"hidden\" id=\"FORMUID\" name=\"FORMUID\" type=\"text\" value=\"e265026c-d621-40f8-b3c0-f26cb29be8b9\">\n\n\n\n\n\n\n\n\n\n     <input class=\"hidden\" id=\"COMMAND\" name=\"COMMAND\" type=\"text\" value=\"SENDMAIL\">\n\n\n\n\n\n\n\n\n\n      <button type=\"submit\">Submit<\/button>\n\n\n\n\n\n\n\n\n\n     <\/div>\n\n\n\n\n\n\n\n\n\n<\/div>\n\n\n\n\n\n\n\n\n\n<\/form>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n  <!--[END]-->\n\n\n\n\n\n  <\/div><!-- \/container -->\n\n\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Long-Term Care Ombudsman (LTCO) Complaint Form In order to submit this online complaint, you must provide your name in the form below. If you want to file a complaint without providing your name, you can contact the LTCOP hotline at 1-855-773-1002 and speak anonymously with an Ombudsman representative. If you are filing a [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-60","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/pages\/60","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/comments?post=60"}],"version-history":[{"count":0,"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/pages\/60\/revisions"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/ltcop\/wp-json\/wp\/v2\/media?parent=60"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}