Complaint Submission
Personal Information
Name
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Phone Number
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Cell Number
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E-mail Address
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Address
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City
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Province
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Postal Code
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Complaint Information
First name of LPN in question
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Last name of LPN in question
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Your relation to LPN (either)
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Name of Hospital/Institution/Facility where the accused was working during the incident
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Date of incident
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Time of incident
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Please describe the events in detail
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Upload Your Incident's Information
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List of witnesses and their contact information (if available)
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Please read and agree to the following terms.
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I understand and accept... (*)
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I understand and accept... (*)
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The completion of the investigative process can only be conducted through the adherence of the listed conditions. Refusal to accept all above conditions will result in the claim being dismissed.
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