Please complete it to the best of your ability.
This form is to be used by clients of The Damien Center who receive services. The issues that may be addressed in a formal grievance include, but are not limited to, concerns about quality of care, perceived issues with confidentiality, or perceived violations of procedures or policies. Issues regarding complaints submitted by one client in reference to another client’s issues, complaints about other clients, or external agency issues will not be addressed. The client can expect that services will continue to be delivered without disruption, and without reduction in frequency or quality during the grievance process. The client will not be penalized or retaliated against for filing a grievance. The client will have the option to work in conjunction with an advocate of their choosing through the grievance procedures. Clients have the right to withdraw a formal complaint at any time in the process.
A grievance can also be filled out by reaching out to the Grievance Liaison directly by calling 317-632-0123 x 225 or emailing quality@damien.org.
The following agencies may be contacted to report grievances and complaints.
Pharmacy related grievances: Indiana Board of Pharmacy
Mental Health related grievances: Indiana Division of Mental Health and Addiction via their toll-free consumer service line at 800-901-1133
U.S. Department of Health and Human Services
https://www.hhs.gov/ocr/complaints/index.html
HIV Care: Indiana Department of Health’s HIV Services Program HIV Supportive Services Program Manager via email: Supportiveservices@health.in.gov