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1. Personal Details: Patient's full name, address, contact information, date of birth, and NHS number if known
2. Incident Details: Specific date, time, location, and department where the incident or care was received
3. Nature of Complaint: Clear and detailed description of what went wrong, including names of staff members involved if known
4. Previous Communications: Details of any previous contact about this issue, including dates and reference numbers
5. Desired Outcome: Clear statement of what you would like to happen as a result of your complaint
1. Witness Information: Details of any individuals who witnessed the incident, including their contact information if available
2. Supporting Documentation Reference: List and description of any documents attached to support the complaint
3. Power of Attorney Declaration: Details and declaration of authority to act on patient's behalf, if complaint is made by someone other than the patient
1. Medical Records: Copies of relevant medical documentation and records
2. Previous Correspondence: Copies of any previous letters, emails, or communications regarding the issue
3. Supporting Evidence: Any additional evidence such as photographs, witness statements, or other relevant documentation
4. Authorization Documents: Power of Attorney documentation or authorization forms if acting on behalf of the patient
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