+
File an EMTALA Complaint
+
+
+ Before filing a complaint, know your EMTALA rights.
+
+
+
+ 1EMTALA complaint about a hospital
+ emergency department
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+
+
+
+
+
+
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+ 2Let us know where the problem
+ happened
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+
+
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+
+
+
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+
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+ 3Tell us what happened
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+
(Up to 3,000 characters)
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+
(Up to 200 characters)
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+ 1 Personal information
+
+
+ ${".filing-choice legend"}
+ ${".filing-choice input:checked + label :first-child"}
+
+ ${".relationship-to-patient legend"}
+
+ ${".relationship-to-patient input:checked + label :first-child"}
+
+
+
+ 2 Where the problem happened
+
+
+ ${".hospital-name"}
+ ${".hospital-address"}
+ ${".hospital-city"}
+ ${".hospital-phone"}
+
+
+ 3 What happened
+
+
+ ${".date-of-incident label :first-child"}
+ ${".incident-date-formatted"}
+
+
+ ${".description-of-incident label :first-child"}
+
+ ${"!textarea[name=incident_description]"}
+
+
+ ${".reported-problem-before label :first-child"}
+
+ ${"!textarea[name=previously_reported]"}
+
+
+
Review your EMTALA complaint
+
+ Before filing your complaint, please check to be sure all the
+ information you entered is correct. This will help us when we review
+ your complaint.
+
+
If you need to make changes, just go back to the form.
+
+
+
+
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+ To keep this information for your records, you can save this page as a
+ PDF on your computer or mobile phone.
+
+
+ Once you file your complaint, you can't make changes to the
+ information you provided. If you provided your contact information, a
+ state or federal investigator might reach out to you.
+
+
+ By clicking โFile your complaint,โ you are confirming that all the
+ information in your complaint is true, to the best of your knowledge.
+
+
+
+
+
Thank you for filing an EMTALA complaint
+
+ If you provided your email, we sent you an email confirming that we
+ received your complaint.
+
+
+ To keep this information for your records, you can save this page as a
+ PDF on your computer or mobile phone.
+
+
What to expect
+
+ Your complaint will go directly to the federal government to review
+ and share with the state. If there is an investigation, the federal
+ government will determine if the hospital violated EMTALA.
+
+
+ If you provided your contact information, an investigator might
+ contact you with questions. Even if you donโt speak to an
+ investigator, you'll receive a summary of the investigation.
+
+
+ If your complaint is about a situation not covered by EMTALA, it will
+ be sent to the right office, or closed.
+
+
Here are some resources:
+
+
+
About CMS
+
+ CMS is the federal agency that provides health coverage to more than
+ 160 million through Medicare, Medicaid, the Children's Health
+ Insurance Program, and the Health Insurance Marketplace. CMS works in
+ partnership with the entire health care community to improve quality,
+ equity and outcomes in the health care system.
+
+