Text Resize

-A +A
Bookmark and Share

DOH Reporting Form (Bill of Rights Program)

DISTRICT OF COLUMBIA GOVERNMENT
DEPARTMENT OF HEALTH


(Health Benefits Plan Members Bill of Rights Program)
Reporting Form
(DC CODE 44−301.10, 2001 Edition)

Please Provide The following
Grievance information:

IMPORTANT

If your company has no grievances to report for this filing period, and/or
is exempt from filing a report with the District of
Columbia, Department 
of Health, please respond as appropriate, attach appropriate doucments,
date and sign below
and return only this first page of the form and the
documents to the address below:

RETURN TO:
Grievance and Appeals Coordinator
District of Columbia Department of Health
825 North Capitol Street, NE, Room 4119
Washington, DC 20002
Phone:  (202) 442−5979 Fax:  (202) 442−4797 Email:  charlita.brown@dc.gov

CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.