LOUISIANA

Addictive Disorder Regulatory Authority

628 N. 4th Street, Baton Rouge, LA. 70802  / 225.342.8941 / 225.342.0441 (fax)

COMPLAINT FORM INSTRUCTIONS

(if you would like these instructions in Adobe format, click here)

The Regulatory Authority requires that an official complaint form be filed before any further action can be taken. Please contact the office should you have any questions.

INSTRUCTIONS:

1. The person or organization filing the complaint is the complainant. If filing for an organization, a person shall be named as the representative for the organization. Include mailing address and phone numbers.

2. The person or organization against whom the complaint is filed is the subject. If filing against an organization, a person shall be listed as contact for the organization. Include mailing address and phone numbers.

3. State the statute, rule, regulation, code of ethics, policy, procedure instruction, or agreement that is suspected of being violated. This is a statement of charges.

4. In the statement of specifics, include as much detail as possible including dates, times, places, persons, and quotations.

5. Sign the complaint form.

6. Mail or deliver to:

DHHOAD Regulatory Authority - Complaint
628 N. 4th Street
Baton Rouge, LA. 70802

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