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Hospitals - File a Complaint

Toll Free Phone : 877-402-8218
Local Phone : 410-402-8018
Fax: 410-402-8167
 

To make a complaint about a health care facility or community-based treatment program
call 877-402-8218 or fill out the Complaint Report Form below.


Complete this form if you have concerns about the health care or treatment that you or a family member received or did not receive. Answer all questions. Give complete details. You may use this form as a guide when making a complaint by telephone. We will investigate your concerns based on the information that you provide. You may file an anonymous complaint.
 

Patient Information
 
First Name:  
Last Name:  
Age:  
Sex:   Male Female
 

Health Care Facility Information
 
Facility Name:  
Street Address:  
City:  
State:  
Facility Type:  
 

Witnesses to the incident
 
Name:  
Contact Information:  
 

Person filing complaint or reporting incident (optional)
 
Name:  
Relationship:  
Street Address:  
City:  
State:  
ZIP:  
Telephone:  
Email Address:  
 

May we reveal your identity during the investigation of your complaint?:

Note: If you would like a deficiency report that may result from our investigation, please complete this section.
 

Yes No

 

Briefly describe the incident or your concerns:

Include dates and times, persons involved, and description of what happened. Include attachments, if appropriate. Note: If this is an anonymous report, be complete since we will not be able to contact you to obtain missing information.
 
 

Have you reported this incident or concern to the person in charge of the facility, residence or program?

 
Yes No
 
 
 
 

You can also download and print the Complaint Report Forms

If you do not have Adobe® Acrobat click here to download the Adobe® Reader.
If you do not have Microsoft® Word click here to download the Microsoft® Word Viewer.

 

 

Address written complaints to the appropriate licensing unit (listed below) and mail to:
Office of Health Care Quality
Spring Grove Hospital Center
Bland Bryant Building
55 Wade Avenue
Catonsville, Maryland 21228

Or submit your complaint to the appropriate OHCQ licensing unit phone:

 
  • Nursing homes- (410) 402-8201 Toll-free 877-402-8219
  • Hospitals- (410) 402-8000 Toll-free 877-402-8218
  • Health maintenance organizations- (410) 402-8000 Toll-free 877-402-8218
  • Developmental disabilities programs- (410) 402-8094 Toll-free 877-402-8220
  • Assisted living homes- (410) 402-8217 Toll-free 877-402-8221
  • Clinical laboratories- (410) 402-8025 Toll-free 877-402-8202
  • Home health agencies, hospice programs, residential service agencies, kidney dialysis centers- (410) 402-8040 Toll-free 800-492-6005
  • Adult day care- (410) 402-8201 Toll-free 877-402-8219
  • Substance abuse treatment programs- (410) 402-8054 Toll-free 877-402-8220
  • Community Mental Health Unit- (410) 402-8060 Toll-free 877-402-8220
 

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