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| Name of the person being discriminated against (the complainant). | |
| Phone number where the complainant can be reached. | |
| Current address or facility where the complainant lives. | |
| A statement that the complainant wishes to move out of the facility and into a more integrated setting (based on the Olmstead decision). | |
| A statement that the complainant is being discriminated against based on a disability. | |
| The name, signature, address, and phone number of the person filing the complaint (if different than the complainant). | |
| The date the complaint is written. |
ADDITIONAL SUPPORTING INFORMATION
The more information you provide, the more likely that OCR will take the complaint seriously, complete a thorough investigation, and attempt to resolve the issue. Additional information you may want to include could be:
| Letters or other documents from professionals such as social workers or psychologists employed by the state or the facility where the individual lives agreeing that the individual should be served in a more integrated setting. The individual’s treatment team may also be willing to write a letter, or they may have made similar comments in the individual’s file. If these professionals do not support the individual’s attempt to live in a more integrated setting, write down the reasons why you believe that they are withholding their support. Include letters from other professionals stating that the individual should be served in a more integrated setting. | |
| A description of the steps already taken to obtain a discharge to a community placement and of the obstacles that have prevented the discharge from occurring. | |
| A written record about the length of time the individual has resided in the facility, and how long the individual has desired to move to a community setting. | |
| A description of the supports available in the community that can assist the individual and for which s/he qualifies. |
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Mail the complaint to:
Office of Civil Rights
U.S. Dept. of Health and Human Services
2201 Sixth Ave. M/S: RX - 11
Seattle, WA 98121
After filing your complaint, you should always follow up with a phone call to
OCR. The phone number at OCR is 1-800-362-1710.
To view or print easy-to-use complaint forms, click one of the links below.
►
Residents of Eastern or Western State Hospital - MS Word document
►
Residents of Eastern or Western State Hospital - text only
► RHC residents
- MS Word document
► RHC
residents - text only
Want more information about OCR and your rights? Try these web pages:
| OCR Home Page | |
| OCR Fact Sheet: Your Rights under the Americans with Disabilities Act | |
| OCR Fact Sheet: Your Rights under Section 504 of the Rehabilitation Act |
This publication is an information service of the Washington Protection & Advocacy System (WPAS). It provides general information only and should not be used as legal advice for any specific situation. If you would like more information about this topic, call us and ask for a Resource Advocate.
To receive this document in an alternative format, such as large print or Braille, please call Washington Protection & Advocacy System (WPAS) at 1-800-562-2702.
WPAS is a member of the National Disability Rights
Network
A substantial portion
of the WPAS budget is federally funded.
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