Client Rights: DHS 94 Grievance Procedure Model

The Client Rights Office created a format providers can use during the grievance process. This applies to adults and children—or someone on their behalf—who are receiving services for mental health, developmental disability, or substance use and are filing a rights complaint. Use the resources below to help create or update your grievance resolution procedure.

References

• Wis. Admin. Code ch. DHS 94—Patient Rights and Resolution of Patient Grievances (PDF)
• Community Grievance Resolution Procedure—Process Flow Chart (PDF)

Procedure model

New providers who don’t yet have a process in place can use this sample. Existing providers who want to update their process may find it helpful too. Providers can change it to fit their needs. For example, you can add your own name.

Client Rights Grievance Resolution Procedure Model (Word)

Sample forms

We’ve also created sample forms you can use during the grievance process:

• Sample Level 1-A Report by the Client Rights Specialist (Word)
• Sample Level 1-B Decision by the Program Manager (Word)
• Sample Level II Decision by the County Director (Word)

Learn more about the process for filing a complaint