BRAC Healthcare Grievance Cell is dedicated to addressing complaints and concerns related to healthcare services. We provide safe channels to report issues such as exorbitant fees, medical negligence, unethical practices, poor quality of care, denial of service, or requests for financial support from underprivileged families. Our team guides patients and families through resolution processes, advocacy, and counseling to ensure fair treatment, accountability, and access to quality healthcare for all.

BRAC Healthcare Grievance Cell – Report Healthcare Issues

BRAC Healthcare Grievance Cell

Confidentiality Notice: All reports are treated with strict confidentiality. You may choose to remain anonymous. Your safety and privacy are our priority.

🎉 Thank You for Your Report!

Your healthcare grievance has been successfully submitted and is now under review by our Healthcare Grievance Cell.

GENERATING…

📝 IMPORTANT: Please save this reference number for your records. You will need it for any future correspondence or inquiries about your report.

Our team will review your submission and may contact you if additional information is required. We appreciate your courage in reporting healthcare issues and helping us ensure fair treatment and quality healthcare for all.

All reports are handled with strict confidentiality and in accordance with our privacy policy.

1. Reporter Information

I want to provide my details
I want to remain anonymous

Your Details:

Full Name: Email Address:

❌ Please enter a complete email address (e.g., name@domain.com)

✅ Email format is valid

Phone Number:

❌ Only numbers (0-9) allowed. No symbols. Enter exactly 10 digits

✅ Phone number format is valid

Address: Occupation: Relationship to Patient (if applicable):

2. Healthcare Issue Details

Type of Healthcare Issue: *

❌ Please select the type of healthcare issue

Date of Incident: *

❌ Please select complete date (Day, Month, Year)

Time of Incident:

Detailed Description of Healthcare Issue: *

❌ Please provide detailed description of the healthcare issue

Amount Involved (if applicable): Type of Treatment/Service: Medical Specialty/Department:

3. Healthcare Facility Details

Name of Healthcare Facility: *

❌ Please enter the name of the healthcare facility

Type of Healthcare Facility: *

❌ Please select the type of healthcare facility

Facility Address: *

❌ Please enter the facility address

License/Registration Number (if known): Facility Contact Information: Was health insurance involved?

4. Healthcare Provider Details

Name of Healthcare Provider(s): *

❌ Please enter the name(s) of healthcare provider(s)

Designation/Position: Medical Specialty: *

❌ Please enter the medical specialty or department

License/Registration Number (if known): Provider Contact Information:

5. Patient Information

I am the patient
Someone else is the patient

Patient Details:

Patient’s Name: Patient’s Age: Patient’s Gender: Patient’s Contact Information: Patient’s Medical Condition: Relevant Medical History:

6. Witnesses Information

There were witnesses to this healthcare issue

Witness Details:

7. Evidence

I have medical records/reports
I have prescriptions
I have medical bills/invoices
I have insurance documents
I have photographs
I have audio recordings
I have video recordings
I have correspondence/emails
I have other evidence

Upload Evidence Files: Description of Evidence:

8. Impact Assessment

Impact on Patient’s Health: Financial Impact: Emotional/Psychological Impact: Family Economic Background: Urgency Level: Is this an ongoing issue?

9. Previous Actions Taken

Approached the healthcare facility directly
Contacted medical board/council
Reported to health authorities
Sought second medical opinion
Contacted insurance company
Sought legal advice
Filed complaint with consumer forum

Details of Previous Actions:

10. Additional Information

Any Other Relevant Information: What outcome are you seeking? Type of Support Needed:

Financial Support
Medical Support/Treatment
Legal Guidance
Advocacy with Healthcare Providers
Counseling/Emotional Support
Second Medical Opinion

Preferred Method of Contact (if not anonymous):

11. Security Verification

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12. Declaration

Important: Providing false information about healthcare services is a serious matter. Please ensure all information provided is true and accurate to the best of your knowledge.

I declare that the information provided is true and accurate to the best of my knowledge *

❌ You must confirm the truth declaration

I consent to BRAC processing this information for healthcare advocacy and resolution purposes *

❌ You must provide consent for processing

“Your Health, Your Rights.”