Page 13 - Home Health Marketing

PROBLEM SOLVING PROCEDURE

We are committed to ensuring that your rights are protected. If you feel that
our staff has failed to follow our policies or has in any way denied you your
rights, please follow these steps without fear of discrimination or reprisal:
PLEASE SPECIFY
1. Notify the __________________________________ (e.g., Clinical Manager) by
phone at _________________________ from _________ a.m. to ________ p.m.,
Monday through Friday. You may also submit your complaint in writing
to ____________________________________________ (agency address). Most
problems can be solved at this level.
PLEASE PROVIDE NAME,
2. Notify the Administrator, ________________________ (Administrator’s name),
ADDRESS AND PHONE #
OF YOUR ADMINISTRATOR
by phone at ______________________ (Administrator’s phone #) or in writing
to __________________________________ (Administrator’s address).

3. You may also contact the state's toll-free home care hotline at ____________.
STATE SPECIFIC INFO
Their hours are ________ a.m. to ________ p.m., Monday through Friday.
WILL BE ADDED HERE,
The purpose of the hotline is to receive complaints or questions about local
INCLUDING HOTLINE
home care agencies and complaints regarding the implementation of
advance directive requirements. You may submit your complaint in writing
to: ____________________________________________________________________
_______________________________________________________________________.
3. You may also contact our accrediting organization, _____________________,
to report any concerns or register complaints by calling __________________.

PLEASE SPECIFY
ACCREDITATION
(IF APPLICABLE)

 Other: _____________________________________________

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