Posted: May 1st, 2025

DHS form update: medical consideration form

Task summary:Dear Freelancer, please write a medical form. Use the draft provided  to complete the attached form. Size should be 2500 words, written directly inside the attached form doc and without using any outside sources.

Full order description:? MAIN DETAILS: a medical reconsideration form to complete take the draft provided, write it professionally with good word choice. Only complete the first two boxes of the form.

Note from teacher: Emphasis on the untruthfulness of the facility to provide heating in a safe and comfortable environment. As well as their willingness to express untruthfulness that they were working to resolve when they were not and had not from my time of admission until investigation was done in March. And that’s deemed as abuse and patient neglect. The two key points that  need facilitated in documentation are abuse/neglect and truthfulness

Safety, Oversight & Quality Unit
Petition for Reconsideration
(Required Form)
Petitioner name:
Facility name:
Report #:
Petitioner address:
City/State/ZIP code:
Petitioner phone #:
I hereby request reconsideration of the Final Order issued by the Department of
Human Services in the above case. I understand that I must be a person adversely
affected or aggrieved by the Final Order to request reconsideration. I am a person
directly affected or aggrieved by the Final Order because: (Choose one below.)
I have suffered an injury to a substantial interest because of the Final Order.
Please identify your substantial interest and how that interest has been injured by
the Department’s Final Order. (Use attachment if necessary.)
I am legally affected or have a legal interest that is affected by the Final Order.
Please identify your legal interest and how you or your legal interest have
been affected by the Department’s Final Order. (Use attachment if necessary.)
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APD 825 (11/18)
I am seeking to further an interest that the legislature expressly wished to
be considered.
Please identify the interest you are seeking to further and the specific Oregon law that
identifies the interest the Oregon Legislature wished to be considered and explain
how the Department’s Final Order failed to consider that interest. (Use attachment
if necessary.)
Signature
Date
Please mail to: Oregon Department of Human Services, Safety, Oversight and Quality
Unit, PO Box 14530, Salem, OR 97309
This document can be provided upon request in alternative formats for individuals
with disabilities. Other formats may include (but are not limited to) large print,
Braille, audio recordings, Web-based communications and other electronic formats.
Email dhsalt@state.or.us or call 503-378-3486 (voice) to arrange for the alternative
format that will work best for you.
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APD 825 (11/18)