How to Complete and Submit the Louisiana Department of Health Complaint Form

To file a complaint against a Louisiana healthcare facility, download the Louisiana Department of Health complaint form from the LDH website, fill it out completely, and send it to the Health Standards Section by mail at P.O. Box 3767, Baton Rouge, LA 70821, by fax to (225) 342-5073, or by email to HSSComplaints@la.gov.¹ The form is officially titled the Health Standards Section Complaint Information Form. Filing is free, and Louisiana law protects anyone who files a good-faith complaint from civil liability.²

Before You Start: What This Form Is For

The Health Standards Section (HSS) uses this form for complaints about facilities it licenses: hospitals, nursing homes, home health agencies, hospices, ambulatory surgical centers, adult day health care, behavioral health services, psychiatric residential treatment facilities, and more.³

Three things fall outside what HSS handles, so this form is not the right route for them: billing or reimbursement disputes, care provided in a setting LDH does not license, and complaints about an individual physician’s conduct.³ Physician complaints go to the Louisiana State Board of Medical Examiners. If your report involves potential criminal conduct such as abuse or fraud, LDH will refer it to the Medicaid Fraud Control Unit within the Attorney General’s office.²

LDH also recommends that if you’ve already sent a written complaint directly to the facility, you give it about 30 days to investigate and respond before contacting HSS.¹ You are not required to complain to the facility first, and you shouldn’t wait if the situation involves immediate safety concerns.

Where to Get the Form

The current PDF is posted on the LDH File a Complaint page.¹ Download it, fill it in on your computer or print and complete it by hand, and keep a copy for your records. LDH asks that you complete the form in its entirety.

Filling Out the Form Section by Section

The form has five parts. Knowing what each one is asking for keeps investigators from having to come back to you for missing information.

Complainant’s Information

This section identifies you: your name, mailing address, phone number, email address, and your relationship to the patient. If you are a current or former employee of the facility, the form asks you to say so.⁴ You do not need a power of attorney or any other legal document to file. Just state how you know the patient.

If you would rather stay anonymous, check the Anonymous box and skip to the facility section. There’s a real tradeoff here. If you file anonymously and the complaint triggers an investigation, HSS will not contact you or send you any results.⁴ You won’t learn whether investigators substantiated your concerns or what happened next. If knowing the outcome matters, put your contact information on the form.

Facility and Patient Information

Identify the facility by its full name and street address. If more than one facility was involved, list them all. For the patient, provide full name, age, date of birth, admission and discharge dates, and the reason for admission.⁴ These details let investigators pull the right records and narrow the timeframe.

Event Details

This is the substance of the complaint. You’ll list the dates of the events, the location within the facility (unit, room number, department), and the names of any staff members involved if you know them. Checkboxes let you flag the general area of concern: death, abuse or neglect, restraints or seclusion, emergency services, or other.⁴

Below the checkboxes is an open narrative field. Be specific. Include shift times, room numbers, the names and titles of the people involved, and what you actually saw or were told. “The staff was rude” gives an investigator nothing to check. “On March 12 at approximately 2 p.m., the aide in Room 214 left the patient unattended for over an hour after a fall” gives surveyors something they can verify against staffing records and facility logs. Attach extra pages if you need the space.

Reporting History and Signature

The final section asks whether you already reported the event to someone at the facility, and if so, to whom, when, and how (in writing, by phone, in person, or by email), plus whether the facility responded. The form also includes a signature line giving HSS permission to forward your complaint to another agency if the issue falls outside its authority.

How to Submit the Completed Form

HSS accepts complaints through four channels:¹

Mail: Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821. Certified mail gives you a delivery receipt, which is useful if you’re sending photographs or other physical evidence.
Fax: (225) 342-5073. Keep the transmission report as proof of delivery.
Email: HSSComplaints@la.gov. Attach the completed PDF and save the sent email for your records.
Phone: (225) 342-0138. Louisiana law allows complaints to be made by telephone or in person as well as in writing. Calling is useful for urgent safety concerns; follow up with the written form so the complaint is fully documented.²

What Happens After You File

After HSS reviews the complaint, LDH states that the complainant will receive written notice of the department’s decision.¹ The department does not publish a specific timeline, so a few weeks may pass before you hear anything.

Reviewers decide whether the reported facts suggest a violation of state licensing standards or federal Medicare and Medicaid requirements. Allegations involving immediate danger to patients receive priority. If the complaint warrants a closer look, HSS may conduct an unannounced on-site survey: state surveyors arrive at the facility without warning, review medical records, observe care, and interview staff. If the investigation substantiates the complaint, the facility can face civil fines, a required plan of correction, monitoring, license suspension or revocation, or denial of Medicaid payment.⁵

Protection for People Who File

Louisiana Revised Statutes Section 40:2009.13 gives anyone who reports a healthcare provider violation, other than the person accused, immunity from civil liability that might otherwise arise from making the report. That immunity extends to participation in any judicial proceeding that follows.² A facility cannot successfully sue you for filing a truthful complaint.

If you believe a facility has retaliated against a resident for a complaint, through discharge, reduced care, or intimidation, report the retaliation as a separate complaint to HSS. Nursing home residents in Medicare- and Medicaid-certified facilities have the right to voice grievances without retaliation, and CMS enforcement remedies apply to facilities that violate residents’ rights.⁶

1
Louisiana Department of Health. File a Complaint/Report Abuse
2
Justia Law. Louisiana Revised Statutes Title 40 RS 40-2009.13 – Health Care Provider Complaints
3
Louisiana Department of Health. Health Standards Section
4
Louisiana Department of Health. Health Standards Section Complaint Information Form
5
Cornell Law Institute. Louisiana Administrative Code Title 48 I-4621 – Transfer of Residents, Patients, or Clients Receiving Services
6
Centers for Medicare & Medicaid Services. Nursing Home Enforcement