In Crisis? We can help.

If you or someone you know is thinking of suicide or is in emotional distress, please call:

988 Suicide and Crisis Lifeline
(231) 689-7580
Toll Free: (800) 968-7330

We are available 24 hours a day, 7 days a week. A caring, trained clinician is waiting to take your call.

INSTRUCTIONS:

If you believe that one of your rights has been violated, you (or someone on your behalf) may use this form to make a complaint. A rights officer/advisor will review the complaint and may conduct an investigation. Send this form to the rights office at the provider where you are receiving (or received) services at:

Newaygo County Mental Health Office of Recipient Rights
1049 E. Newell St., PO Box 867
White Cloud, MI 49349
Phone: (231)689-7080
Email: ORR@newaygocmh.org
Fax: 231-787-1305

Keep a copy for yourself. If you send your complaint to Michigan Department of Health and Human Services, Office of Recipient Rights (MDHHS-ORR), it will be forwarded to the appropriate rights office. The MDHHS-ORR address is:

MDHHS-ORR
5th floor 333 S. Grand Tower, PO Box 30037
Lansing MI 48933
Fax: 1(517)241-0991

Recipient's Name
Remain Anonymous
Complainant's Name
*If you want to remain anonymous leave this blank
Complainant's Address
Address of occurance
When did the alleged violation occur (indicate date and time)?
Clear Signature
Name of person assisting complainant
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.
Authority: PA 258 of 1974 as amended 
Original to ORR Copy to complainant (with acknowledgement letter)
DCH-0030 (Rev. 4-17)