Please complete the form below to the best of your abilities and be sure to complete all required (*) fields. When finished, click once on the "Submit Complaint" button at the bottom of the page to submit the form for processing.

Complainant Information (Person Filing Complaint)

Your Complaint is Against (Respondent)

Use License Verification to lookup an individual's license or certificate.

Complaint Information

Be sure to include complaint facts including: dates, times and locations of incidences; statements made; and any behaviors which were observed by licensees/certificate holders.
Be sure to include witness names, addresses, telephone numbers, and statements regarding incidents.
Use the fields below to include copies of relevant supporting documents such as patient records including patient name and/or medical record number, incident reports, memos, written statements, narcotic count sheets, Pyxis reports, narcotic audits, urine drug screen results, anecdotal/counseling notes, time cards, pertinent policies and procedures, and payroll reports. Alternatively you can email supporting documentation to [email protected] or fax to (602) 771-7888.




NOTE: As required by A.R.S. § 32-1664(L) “information received and records kept by the Board as a result of an investigation are not available to the public.”

Please be advised that the applicant/licensee/certificate holder may be furnished a copy of the complaint upon request. However, if the disclosure of your name will pose a risk to you, a copy of the complaint with redacted ID information may be provided. If in the Board’s discretion, there is a risk of identification, the Board reserves the right to refuse furnishing a copy of the complaint.

Verification by Oath or Affirmation:

I verify that the statements are true in every respect; that I have not suppressed any information that would affect this complaint; that I will conform to ethical standards of conduct and obey the laws and rules of the Arizona State Board of Nursing ; that I have read and understand that failure to disclose the requested information or disclosure of false information or disclosure of misleading information may constitute fraud and may result in criminal prosecution.

By clicking the "SUBMIT COMPLAINT" button, you agree to the above Verification by Oath or Affirmation.

  
PROCESSING. PLEASE WAIT...
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DISCLOSURE STATEMENT

Statement of locations where all notices of the meetings of the Arizona State Board of Nursing will be posted.

Pursuant to A.R.S. §38-431.02(A)(1)(a), the Arizona State Board of Nursing will post all notices of the meetings of the Arizona State Board of Nursing Meetings and any of its committees and subcommittees on the Board's website at www.azbn.gov. Notices will indicate the date, time, and place of the meeting and will include an agenda or information concerning the manner in which the public may obtain an agenda for the meeting.

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