File a Grievance

Click or drag a file to this area to upload.


In filing this grievance, I understand that it may be necessary for the Indiana Recovery Network (IRN) to disclose information pursuant to this grievance to the subject Provider (?) as well as to external agencies including, but not limited to the Recovery Works. For this reason, the IRN can make no warranty that it will protect the source of this information. However, an attempt is made to withhold disclosure of the source to the extent that is reasonably possible. I authorize unrestricted use of the information filed in this grievance by the Indiana Recovery Network to act as it deems prudent and necessary. Please do not include any personal identifying information or protected health information about any individual.