1. (a) During the complaint intake process the OLTCO shall request the following information:

   1. (1) The complainant’s identifying information, including:

      1. a. The name of the complainant or the entity; and
      2. b. The address and telephone number of the complainant or the entity;

   2. (2) The resident’s identifying information, including:

      1. a. The resident’s name;
      2. b. The resident’s date of birth; and
      3. c. The resident’s address, including room number or current location if known;
   3. (3) The name and contact information for the resident’s legal representative, or personal patient representative, if applicable; and
   4. (4) Informed consent if the complainant or resident wishes to provide informed consent.

   5. (5) Information related to the complaint(s) including but not limited to:

      1. a. The date and time that the incident or the subject of the complaint occurred;
      2. b. A description of what occurred;
      3. c. If the complaint is being made by a healthcare facility representative, the name of the person who originally made the report to the facility;
      4. d. Contact information for any staff member involved in the incident or situation described by the complaint; and
      5. e. Any action the facility has taken or plans to take to respond to the incident or situation described by the complaint.
2. (b) When a complaint is received, the LTCO or LTCOR shall open a case.

Source. #12379, eff 9-13-17