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The guide explains the Board’s purpose in protecting consumers and investigating complaints for potential violations of California law, and it details required steps to complete the complaint form. It covers providing identifying and license information, writing a narrative including dates and witnesses, attaching supporting documents, and completing the Authorization for Release of Patient Health Information, including additional release forms when other providers or Kaiser facilities are involved.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/instructions-for-filing-a-complaint-against-an-osteopathic-physician-complaint-instructions-submit/288862/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/instructions-for-filing-a-complaint-against-an-osteopathic-physician-complaint-instructions-submit/288862.png","ImageObject",442,249,{"name":88,"@type":89},"Marry","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-08","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is voluntary, and what could delay or prevent an investigation?","Question",{"text":109,"@type":110},"Except for the name of the osteopathic physician your complaint is against, the requested information is voluntary. Failure to provide the information may delay or prevent the investigation of your complaint.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What should be included when writing the complaint narrative?",{"text":114,"@type":110},"Write the complaint in narrative format and include relevant details such as dates, names, titles, specific concerns about the treatment, and the names and contact information of any witnesses.",{"name":116,"@type":107,"acceptedAnswer":117},"Why is the Authorization for Release of Patient Health Information required, and who can sign it?",{"text":118,"@type":110},"The authorization is necessary to obtain information from the physician you are complaining about. It must be signed and dated by the patient or legally authorized individual; if the patient can’t sign, specific alternatives are allowed, such as the informant listed on a death certificate, a minor child’s parent, or an attorney-in-fact under Power of Attorney with supporting documentation.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288862,1790549735,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":15,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":79},5909892079670,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","DEPARTMENT OF CONSUMER AFFAIRS • OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA  \n1300 National Drive, Suite 150, Sacramento, CA 95834 P (916) 928-8390 |F (916) [928-8392 |](928-8392 | www.ombc.ca.gov)[ ](928-8392 | www.ombc.ca.gov)[www.ombc.ca.gov](928-8392 | www.ombc.ca.gov)  \nBUSINESS, CONSUMER SERVICES AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR  \nINSTRUCTIONS FOR FILING A COMPLAINT AGAINST AN  \nOSTEOPATHIC PHYSICIAN  \nThe function of the Osteopathic Medical Board of California (Board) is to protect consumers and promote the highest professional standards in the practice of osteopathic medicine, the Osteopathic Medical Board of California licenses osteopathic physicians and surgeons.  \nThe Board investigates consumer complaints and uses its enforcement power to ensure practitioners abide by the provisions of the state Business and Professions Code/Medical Practice Act.  \nCalifornia Business and Professions Code-Section 2450-2459.7: Article 21. Provisions Applicable to Osteopathic Physicians and Surgeons.  \nInstructions for Filing Your Complaint  \nExcept for the name of the Osteopathic Physician your complaint is against, all information requested is voluntary, but failure to provide this information may delay or prevent the investigation of your complaint. Please provide as much information as possible in connection with the complaint. The information on the complaint form will be used in part to determine whether a violation of state law has occurred. If a violation is substantiated, the information may be transmitted to other government agencies, such as the Attorney General’s Office. In completing the complaint form, please do all of the following:  \n1. Legibly print or type all information.  \n2. Fill in the full name, address, telephone number, and license number (if known) of the person your complaint is against. This information must also be included in the corresponding section of the Authorization for Release of Patient Health Information Form.  \n3. Write your complaint in a narrative format and include details such as (dates, names, titles, specific concerns about the treatment provided, and the name(s) and contact information of any witnesses) .  \n4. Attach a copy of any supporting documents you may have in your possession pertaining to your specific complaint. Supporting documents may include patient records, photographs, audio or video recordings, correspondence (e.g. letters, emails, texts), billing statements, proof of payments, police reports, court documents, and internal employment administrative investigations, etc.  \n5. Complete the “Authorization for Release of Patient Health Information for the Subject (Physician) of the Complaint\". This form is necessary to obtain information from the physician you are complaining about.  \n6. If you were treated by another provider or health facility related to your complaint, please complete one of the following medical release forms in their entirety:  \n1-12 Osteopathic Medical Board of CA (REV 01/25)  \n“Other Provider/Facility Authorization for Release of Patient Health Information”(In this form, list all other treating providers or facilities relevant to your complaint. You can add up to three (3) per form) .  \n-OR-  \n“Kaiser Authorization for Release of Patient Health Information”(If the care and treatment related to your complaint was rendered at a Kaiser facility, fill out the Kaiser form and check if it’s a “northern” or “southern”facility) .  \n7. Sign and date the complaint form.  \nPlease Note:  \n➢ You must fill out a separate complaint form for each Osteopathic Physician, or unlicensed provider you would like to complain about.  \n➢ The Board does not have jurisdiction over billing/fee disputes, general business practices (contracts, office policies, appointment times/duration, etc. ) or personal conflicts, unless the behavior in question interferes with the safe delivery of patient care. The Board cannot award any kind of financial compensation, provide legal advic","cbCaisygOgkLzGrE","https://ap.wps.com/l/cbCaisygOgkLzGrE","pdf",2825357,"English","# Instructions for Filing Your Complaint\n## Required information and supporting documents\n## Authorization for Release of Patient Health Information","[{\"question\":\"What information is voluntary, and what could delay or prevent an investigation?\",\"answer\":\"Except for the name of the osteopathic physician your complaint is against, the requested information is voluntary. Failure to provide the information may delay or prevent the investigation of your complaint.\"},{\"question\":\"What should be included when writing the complaint narrative?\",\"answer\":\"Write the complaint in narrative format and include relevant details such as dates, names, titles, specific concerns about the treatment, and the names and contact information of any witnesses.\"},{\"question\":\"Why is the Authorization for Release of Patient Health Information required, and who can sign it?\",\"answer\":\"The authorization is necessary to obtain information from the physician you are complaining about. It must be signed and dated by the patient or legally authorized individual; if the patient can’t sign, specific alternatives are allowed, such as the informant listed on a death certificate, a minor child’s parent, or an attorney-in-fact under Power of Attorney with supporting documentation.\"}]","Instructions for Filing a Complaint Against an Osteopathic Physician - Complaint Instructions - Submit | PDF",1789634112]