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	OSNC provides advocacy services for residents in long-term care facilities in the counties of Lassen, Modoc, Nevada, Placer, Sacramento, Shasta, Sierra, Siskiyou, Solano, Sutter, Trinity, Yolo and Yuba. The services are mandated by Federal and State laws.

	How to Report Abuse in Long-Term Care Facilities

Date:
First Name:
Last Name:
Phone Number
Email Address:
Resident's Name:
Facility Name:
City & County:
Brief Complaint Statement:

In accordance with Federal and State Laws, your name and all pertinent information are confidential.
You will be contacted by OSNC Intake for additional information.