Medical Negligence Complaint

Consumer Commission name*

Complainant name*

Hospital/doctor name*

Details of treatment received*

Details of the alleged negligence and resulting harm*

Compensation/relief sought*

Complaint date*

Format:

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BEFORE THE [commission_name] COMPLAINT FOR MEDICAL NEGLIGENCE Complainant: [complainant_name] Opposite Party: [hospital_or_doctor_name] 1. That the Complainant received the following treatment from the Opposite Party: [treatment_details] 2. That the treatment was rendered negligently, in that: [negligence_details] 3. That the said negligence has caused physical, mental, and financial harm to the Complainant. RELIEF SOUGHT [relief_sought] COMPLAINANT [complainant_name] Date: [complaint_date]

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