Ohio Board of Pharmacy Complaint Form

Per section 4729.23 of the Ohio Revised Code, the identity of an individual submitting a complaint to the Ohio Board of Pharmacy is confidential. If, however, after review of the issues in the complaint the Board discovers jurisdiction is more appropriate with a different investigative body, the complaint information may be shared with another agency. Any agency receiving information from the Board is subject to the same confidentiality requirements.

Please note: The Board cannot address financial/billing disputes, drug pricing concerns, or insurance related matters, as it does not have legal authority to resolve these types of complaints.  You are encouraged to review the links below to ensure your complaint is filed with the appropriate agency:

• Ohio Attorney General Consumer Protection
• Ohio Department of Insurance
• Medicare.gov

Items marked with a * are required.

Name of Complainant*

Address*

City*

State*

Zip Code*

Home Phone*

Business Phone

Email Address*

Re-enter Email*

Incident Date*

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Is your complaint against a business such as a pharmacy or hospital?*

Yes
No

Name of Business*

Type of Business

Address

City*

State*

Zip Code

Phone Number

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Is your complaint against a person, such as a pharmacist, pharmacy technician, patient or prescriber?*

Yes
No

Name of Individual*

Individual’s Role (pharmacist, pharmacy technician, patient, prescriber, etc.)*

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Does your complaint involve a specific prescription?*

Yes
No

Prescriber Information

Name*

Address

City*

State*

Zip Code

Phone Number

Pharmacy Information

Pharmacy Name

Pharmacy Address

Pharmacy City

Pharmacy State

Pharmacy Zip Code

Patient Information

Name*

Date of Birth*

Prescription Information

Drug Name*

Rx Number

Date Filled

Other information from label

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Does your complaint involve an OARRS report?*

Yes
No

Report # (found below the patient’s name on first page)

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Have you made a complaint to any other government agency, professional association, etc. about this matter?*

Yes
No

Please provide their names and addresses.*

Maximum 8000 characters

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In your own words, with as much detail as possible, please state your complaint.*

Maximum 8000 characters

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Were there any other witnesses or other persons who may have additional information about your complaint?*

Yes
No

Please provide their names, addresses and telephone numbers.*