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Nursing Home Compleaint Form DOH-5022 - New York …

Empire State Plaza Albany, NY 12237 or Fax: (518) 408-1157 or E-mail: [email protected] Complaints will be accepted if the occurrence is within the past year of the submission of your complaint to the NYS Department of Health. In order to process your complaint in a timely manner, please: • Type or Print clearly

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