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Complaint Intake Form

Eyeglasses resting on complaint form
HFL&C is responsible for processing complaints for certain types of health care facilities and agencies. View a list of facility or agency types HFL&C oversees in the Regulated Facility Types section. If the facility type is on the list, please file a complaint with our office per the instructions below.  

Instructions for Completing the Intake Form

  1. Click on the Complaint Intake form link (below), this will direct you to the PDF form.
  2. You may complete the form directly online or save and print for future use.
  3. If you choose to complete online, please complete this form as thoroughly as possible.
  4. Print the form and submit to our office (Health Facilities Licensing & Certification) by mail, e-mail or fax.

Individuals may use this form to provide information relative to a complaint regarding any licensed facility:
Fillable Complaint Form

Submit completed form by mail, e-mail or fax:
Health Facilities Licensing & Certification
4501 Business Park Blvd. Ste 24, Bldg. L
Anchorage, AK  99503
Mark clearly on the envelope "Confidential
FAX: (907) 334-2682
If you have any questions regarding this form, please contact our office at (907) 334-2483.
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Frequently Asked Questions

1. What happens after I submit a complaint?

The information provided will be carefully reviewed against the applicable Alaska Administrative Rules and/or Code of Federal Regulations for the specific facility or agency type this complaint is about. The review will determine if there are potential violations of those requirements and if this is the office with jurisdiction to take further action. You will be notified in writing of the results of the review. The letter will inform you what action this office has authority to take, which may include an unannounced, onsite investigation. If it is determined that the concerns fall under the jurisdiction of another agency or organization the letter will provide you with that information.

2. Is my personal and complaint information kept confidential?
Your identity as the complainant is maintained confidentially. This office is prohibited from releasing complainant information and the complaint systems are designed to protect that anonymity.
3. If an investigation is completed, how do I see the results?
The Statement of Deficiencies report and the provider's Plan of Correction regarding a complaint investigation will be available for public disclosure no later than 90 calendar days from the date of the investigation.