Complaint Form

CLPNBC reviews all complaints about Licensed Practical Nurses currently or formerly registered to practise in British Columbia. In order for us to investigate a complaint, we require specific details about what happened. Accordingly, some fields are mandatory to complete. If you are unsure how to answer any of the questions, please contact CLPNBC’s Inquiry & Discipline team for consultation.

Licensed Practical Nurse (LPN)   


(if known)



Complainant  







(-




Location of Incident(s)  


(-


Details of Complaint  
Please describe your concern(s) in as much detail as possible. In general, the complaint should include the basic information of "who, what, when, where, why and how" for each incident. Please note that the complaint details may be sent to the LPN:

Did you attempt to address these concern(s) with the LPN and/or facility?:




(if known)

Resolution:
Please describe how you think your concerns could be resolved.

If authorized, please provide copies of any documentation related to the incidents you have described above via email, fax or regular mail.
 

Disclosure

The LPN must be given an opportunity to respond to the concerns outlined in the complaint. As a result, please note that CLPNBC will share some or all of the information and documents collected during the course of the investigation with the Licensed Practical Nurse, including the details of this complaint.

 
I have read and understand CLPNBC’s disclosure statement related to submission of this complaint. Please input your initials on the right.