August 13, 2007 - Disability Rights Washington



SEQ CHAPTER \h \r 1Grievance Procedure If you have questions about this procedure or need help completing the grievance form, contact the Grievance Administrator at 206-324-1521 or toll free at 800-562-2702.Introduction Disability Rights Washington (DRW) is committed to providing quality services to individuals with disabilities in Washington State. Occasionally individuals will not be satisfied with the services that DRW provides or by DRW’s denial of services. If you are not satisfied, please use this procedure to inform DRW. Who Can File a Grievance? Individuals with disabilities who are eligible for DRW’s services and family members or representatives of such individuals can file a grievance with DRW if dissatisfied with: DRW’s provision of services; orDRW’s denial of services; orDRW’s fulfillment of the assurances in its federal mandates and set forth in the document below entitled “Assurances.” GRIEVANCE PROCEDURESTEP 1: Contact Staff (optional)Prior to filing a grievance, you can contact the staff person with whom you have a complaint. This step is not required. STEP 2 : File a Grievance with the Director of AdvocacyComplete the attached form or put your complaint in writing to the Director of Advocacy and send it to the address on the next page.Include the reason for your complaint, any documentation, names of all DRW employees with whom you have had contact in relation to your complaint, and your contact information including your name, address, and telephone number. DRW must receive the grievance within forty-five (45) days of the event or denial with which you are not satisfied. The Director of Advocacy will investigate your complaint and may request the assistance of DRW staff to fully complete this step. The Director of Advocacy will mail you a written response within thirty (30) days of receipt of your grievance. STEP 3: Appeal to the Chairperson of the Board or His/Her Designee If you are not satisfied with the Director of Advocacy’s response, you may appeal that decision by sending a written complaint to the Chairperson of the DRW Board of Directors (or his/her designee) within fifteen (15) days of receiving the Director of Advocacy’s response. Mail it to:Chairperson of the DRW Board Disability Rights Washington315 5th Avenue South, Suite 850Seattle, WA 98104 To share your information with the Chairperson, you must give DRW written permission. Please sign and return the release of confidential information that the Director of Advocacy included in response to your grievance under Step 2. The appeal will not be forwarded to the Chair unless you return a signed release of information form.You also may provide additional information to the Chairperson. The Chairperson may ask to meet with you if additional information is needed to reach a decision. The Chairperson will review your complaint and the Director of Advocacy’s response with the DRW’s Executive Director and any Board Members the Chairperson determines are necessary and send a written response to you within forty-five (45) days of receipt of your grievance appeal. The Chairperson cannot replace a legal decision made by an attorney as professional rules authorize only attorneys to make certain decisions. The decision of the Chairperson will be DRW’s final consideration and decision regarding the particular grieved issue, including a future grievance(s) about substantially the same issue. Timeline Exceptions If DRW staff fail to meet any of these timelines, you can skip to the next step. If you do not file your grievance within the timelines in the procedure, the grievance will be dropped. If you miss a timeline, you can contact the Director of Advocacy to ask that the grievance process be continued.Where to filePlease send all written grievances and appeals to:Grievance AdministrationDisability Rights Washington315 5th Avenue South, Suite 850Seattle, WA 98104or email: info@dr- Filing this grievance does not prevent you from filing any other claim or complaint that you may have. Grievance Form019050000I, , am filing this grievance with Disability Rights Washington (DRW) for the following reason(s). (Please complete sentence 1, 2, or 3, whichever applies to your grievance.)1.I am dissatisfied with the services that DRW provided or is providing to an individual(s) with a disability. Explain: 2. I disagree with DRW’s denial of services. Explain:3.I believe DRW has not fulfilled its assurances set forth in its federal mandates. Explain: 015240000015240000S015240000ignatureAddress: 015240000Telephone: MAIL TO:Grievance AdministrationDisability Rights Washington 315 5th Avenue South, Suite 850Seattle, WA 98104Or email it to: info@dr-Need assistance completing this form? Contact the Grievance Administrator at: (206) 324-1521 or (800) 562-2702. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download