Ombudsman Complaint

Please enter the access code as provided to your organization and the full form will appear. Access codes are case-sensitive.
Instructions
LTC Ombudsman complaints can also be submitted by calling the 
LTC Ombudsman Complaint Line at (518)417-6587.
 
LTC Ombudsman Contact Information:
Providing information about you will allow Department staff to contact you should additional information be needed. It is our policy  to keep your name confidential.
LTC Ombudsman Contact Information
Please do not share your assigned ID number.
Ombudsman Name

Please provide your contact information for the Department

Resident Information
First and Last Name
Current Location of the Resident
Facility Information
Facility Address
NY
Facility Address
Complaint Information
Provide a summary of the complaint, including the time, date, shift of occurrence, involvement of any staff and/or residents and any witnesses. Additional supporting documentation may be attached below
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