File a Grievance "*" indicates required fields First NameLast NamePhoneEmail Relationship to housing providerRelationship to housing providerCurrent Staff MemberFamily Member of Current ResidentFormer ResidentFormer Staff MemberFamily Member of Former ResidentNeighbor or Community ResidentTherapist, Care Coordinator, or Case ManagerOtherRelationship (Other)I claim direct, first-person knowledge related to this grievance Yes No Provider Name (Facility against whom Grievance is being filed)Provider Street AddressProvider Zip CodeProvider CityProvider StateProvider Primary ContactProvider PhoneGrievant alleges Provider non-compliance with NARR Core Principles listed below. (Please select all that apply) Residence Operates with Integrity Residence Upholds Residence Rights Residence is Recovery-Oriented Residence is Peer Staffed and Governed Residence Promotes Health Residence Provides a Home Residence Inspires Purpose Residence Cultivates Community Residence Promotes Recovery Promotes Health and Safety Residence is a Good Neighbor Other Have you filed an internal grievance with the agency?* Yes No Other (Describe)Nature of GrievanceSupporting Documentation Drop files here or Select files Max. file size: 8 MB. In filing this grievance, I understand that it may be necessary for FARR to disclose information pursuant to this grievance to the subject Provider as well as to external agencies including, but not limited to the Department of Children & Families - Substance Abuse Licensure Division, Florida Attorney General’s Office of Consumer Protection, Florida Department of Law Enforcement, Local Law Enforcement Agencies and Local Code Enforcement Agencies. For this reason, FARR can make no warranty that it will protect the source of this information. However, an attempt is made to withhold disclosure of the source to the extent that is reasonably possible. I authorize unrestricted use of the information filed in this grievance by the Florida Association of Recovery Residences (FARR) to act as it deems prudent and necessary in accordance with the published FARR Compliance Audit Protocol. Please do not include any personal identifying information or protected health information about any individual. I certify that the above information is entirely accurate to the best of my knowledge. Agree Get In Touch Email info@fsarr.org Follow Us FollowFollow Send us a Message Name(Required)Email(Required) PhoneMessage(Required)
