Statement of Complaint Form

The Louisiana Physical Therapy Board (the "Board") is vested with the obligation to regulate the practice of physical therapy in the State of Louisiana through licensure, practice requirements and prohibitions, and disciplinary actions against its licensees. Additionally, the Board is empowered with the authority to seek injunctive relief against unlicensed individuals or entities who violate the Louisiana Physical Therapy Practice Act, LA. R.S. 37:2401 - 37:2425.

In complying with this obligation to regulate the practice of physical therapy, the Board is required to investigate all complaints of wrongdoing which it receives. The Board takes all complaints seriously.

Please complete and submit this online complaint form. You will receive an acknowledgement of receipt from a Board staff member. A panel will be designated to investigate the complaint, which is typically composed of one or more board members, the executive director, investigator and legal counsel. Board staff will keep you informed of progress of the complaint periodically, but you may inquire about the status of your complaint at any time.

During the investigation, you may be contacted to assist in the investigation by providing additional information. Complaints may be settled informally by the Board without a formal hearing, or with a formal hearing. An investigation may be dismissed if there is absence of adequate, credible evidence or for other reasons which are justifiable for dismissal. When an investigation is dismissed, you will receive a letter explanation for dismissal of the complaint.

If you are uncertain about reporting a complaint and wish to speak with someone to discuss our investigative process in more detail, please contact the Board office at 337-262-1043 or email info@laptboard.org to request a phone call.

Persons with special needs or disabilities may also contact the Board office at the above number or email address for additional assistance in reporting a complaint.

Name

Address

Louisiana Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Phone Number

Email

Relationship Patient Co-Professional Other (please specify)

 

Primary Category ALLEDGED ALCOHOL ABUSE. ALLEDGED CRIMINAL CONVICTION ALLEDGED DRUG ABUSE. ALLEDGED IMPROPER BILLING AND REPRESENTATION. ALLEDGED IMPROPER BILLING. ALLEDGED IMPROPER DOCUMENTATION. ALLEDGED LACK OF CONTINUING EDUCATION FOR RENEWAL. ALLEDGED LACK OF PICTURES TO COMPLETE RENEWAL PROCESS. ALLEDGED LACK OF PROPER ON-SITE SUPERVISION OF A FOREIGNED TRAINED PT. ALLEDGED LACK OF PROPER SUPERVISION OF SUPPORTIVE PERSONNEL. ALLEDGED LACK OF SUPERVISION OF A PERMITEE. ALLEDGED MEDICARE/MEDICAID FRAUD VIOLATIONS. ALLEDGED NON-TREATMENT. ALLEDGED OVER UTILIZATION OF SERVICES. ALLEDGED PRACTICING WITHOUT A LICENSE. ALLEDGED SEXUAL MIS-CONDUCT. ALLEDGED UNAUTHORIZED ADVERTISING. ALLEDGED UNAUTHORIZED TREATMENT. ALLEDGED UNAUTHORIZED USE OF THE WORD PHYSICAL THERAPY. ALLEDGED UNPROFESSIONAL CONDUCT. MEDICAL MALPRACTICE PAYMENT REPORT NEEDS DEFINITION. PRESCRIPTIONS PREVIOUS DISCIPLINARY ACTION.

Secondary Category ALLEDGED ALCOHOL ABUSE. ALLEDGED CRIMINAL CONVICTION ALLEDGED DRUG ABUSE. ALLEDGED IMPROPER BILLING AND REPRESENTATION. ALLEDGED IMPROPER BILLING. ALLEDGED IMPROPER DOCUMENTATION. ALLEDGED LACK OF CONTINUING EDUCATION FOR RENEWAL. ALLEDGED LACK OF PICTURES TO COMPLETE RENEWAL PROCESS. ALLEDGED LACK OF PROPER ON-SITE SUPERVISION OF A FOREIGNED TRAINED PT. ALLEDGED LACK OF PROPER SUPERVISION OF SUPPORTIVE PERSONNEL. ALLEDGED LACK OF SUPERVISION OF A PERMITEE. ALLEDGED MEDICARE/MEDICAID FRAUD VIOLATIONS. ALLEDGED NON-TREATMENT. ALLEDGED OVER UTILIZATION OF SERVICES. ALLEDGED PRACTICING WITHOUT A LICENSE. ALLEDGED SEXUAL MIS-CONDUCT. ALLEDGED UNAUTHORIZED ADVERTISING. ALLEDGED UNAUTHORIZED TREATMENT. ALLEDGED UNAUTHORIZED USE OF THE WORD PHYSICAL THERAPY. ALLEDGED UNPROFESSIONAL CONDUCT. MEDICAL MALPRACTICE PAYMENT REPORT NEEDS DEFINITION. PRESCRIPTIONS PREVIOUS DISCIPLINARY ACTION.

Name

Address

Louisiana Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Phone Number

Email

Relationship to Accused Patient Co-Professional Other (please specify)

 

Relevant Documents (If there are any documents in existence such as letter, reports, records, notes, memoranda, etc. which are pertinent to the allegations of wrongdoing please describe them, their identity location below.)

IMPORTANT: If you enter an email address with your contact information, you will receive a separate email from the Board office with a secure upload link to upload any relevant documents you'd like to share with the Board.

Name

Employer

Address

Louisiana Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Home Phone Number

Cell Phone Number

Work Phone Number

Fax Number

Email