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Complaint Submission

	Personal Information
Name	Invalid Input
Phone Number	Invalid Input
Cell Number	Invalid Input
E-mail Address	Invalid Input
Address	Invalid Input
City	Invalid Input
Province	Invalid Input
Postal Code	Invalid Input
	Complaint Information
First name of LPN in question	Invalid Input
Last name of LPN in question	Invalid Input
Your relation to LPN (either)	ManagerColleagueMember of the Public Invalid Input
Name of Hospital/Institution/Facility where the accused was working during the incident	Invalid Input
Date of incident	Invalid Input
Time of incident	Invalid Input
Please describe the events in detail	Invalid Input
Upload Your Incident's Information	Invalid Input
List of witnesses and their contact information (if available)	Invalid Input
	Please read and agree to the following terms.
I understand and accept... (*)	1. The release of my name to the LPN in question, Investigator, Investigation Committee, and Discipline Committee for the purpose of conducting a thorough investigation. Invalid Input
I understand and accept... (*)	2. Allowing for a recorded interview with the lead investigator. Invalid Input
I understand and accept... (*)	3. The constraints and obligations of the investigative process described in the following link. Click Here Invalid Input
	The completion of the investigative process can only be conducted through the adherence of the listed conditions. Refusal to accept all above conditions will result in the claim being dismissed.
Type the code to submit (*)	Refresh Invalid Input

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