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This complaint form is designed to gather the information we need in order to review your complaint. Before filling in this form, you may wish to consider talking to the provider you are unhappy with. If you would like assistance with this, an advocate can help you to try to resolve your complaint directly with the provider, instead of making a complaint to the Commissioner.
The Privacy Act and the Health Information Privacy Code state that we may collect, use and disclose personal information (including personal health information) only in ways that are authorised by the Privacy Act. We collect personal information from you, including your contact information and health information.
We may also collect information from other parties regarding your complaint, including (if required) the relevant clinical records. We collect all of this information in order to enable HDC to assess and resolve your complaint, to promote and protect the rights of health consumers and disability service consumers, and for monitoring and statistical purposes.
When a complaint is made about a provider, the provider must be afforded a fair opportunity to consider and respond. It is our usual practice to send the information in your complaint to the relevant provider or providers for their response.
Case studies are sometimes published by HDC and used in presentations. This is a way of protecting and promoting the rights of health consumers and disability service consumers by highlighting cases of specific interest. We may use a complaint you are involved in but will anonymise your identity and that of other parties involved.
You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong.
If you have any questions about any of the above, please contact us at email@example.com, or 0800 11 22 33, or PO Box 1791, Auckland 1140, New Zealand prior to completing the complaint form.
Before filling in this section, take a few moments to identify the issue you want to complain about. Be clear, and keep focused on the main issue(s).
Describe the events you want to complain about. We need to know:
- what happened;
- who it happened to;
- when it happened (the date);
- where it happened; and
- who did it.
If you wish to attach any documentation, you can do so below.
Step 4 - Tell us more about your complaint