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“Kaiser Authorization for Release of Information” (should care and treatment have been rendered at a Kaiser facility please fill out the enclosed Kaiser form and check if it is a “northern” or “southern” facility)Ĭomplete and save each release to your PC and attach the file to the BreEZe online complaint form by using the “Browse” button on the bottom of the Breeze Complaint Submission screen.If the incident is involving a surgical procedure, it is important that you list any pre-op or post-op providers) (In this form you will list all treating facilities in addition to all relevant treating providers specific to yourĬomplaint. “Physician/Provider/Facility Authorization for Release of Information”.Complete the “Authorization for Release of Information for the Subject of the Complaint” ( Subject is the physician you are complaining about).Please attach a copy of supportive documentation in the attachment portion of this submission for timely processing.Ĭomplete the appropriate medical releases in their entirety: *Should the patient be deceased, the person signing the release form(s) must be a legal representative as demonstrated on a durable power of attorney, death certificate, Please do not file an additionalĬomplaint to submit additional information. On a minor level, industry professionals and licensees with the previous name. When the California Department of Real Estate (DRE) became the California Bureau of Real Estate (BRE) in 2013, it was a whopper of a change for industry professionals. Please send the information to and indicate that you have filed an online complaint. The Right Abbreviation For California’s Department Of Real Estate. If you are unable to attach a file to your complaint,
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Please note that there is a singleįile size limit of 10MB and a total file size limit of 50MB for attachment uploads. Need Help Contact the Boards Consumer Information Unit for assistance. State court case lookup & California courthouses.
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Statements, proof of payments, autopsy/toxicology report, police report, court documents, etc. License Verification System (LVS) BreEZe Resources Center. Find California court records online, get access to public municipal, civil, family and superior court records. Personal computer (PC) documents may include patient records, photographs, audio or video recordings, correspondence, billing If you have partial information or are unsure of spelling use a wild card search by. If you fill in all the fields you narrow the search down to a point the system may not be able to find your file. Prepare and save a copy of any supporting documents you may have in your possession pertaining to your specific complaint on your The system works best if you ONLY fill in 1-2 fields instead of all of them. Information Regarding Authorizations for Release of Information for Online Complaints