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QUALITY OF CARE CONCERN NOTIFICATION Please save this form, complete it, and email to: IOC coaccess.com. Member name: Member ID: Today's date: Program: Access Advantage (AA) Access Behavioral Care
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How to fill out quality of care concern
How to fill out quality of care concern:
01
Start by clearly stating your concern about the quality of care you received. Be specific about the issues you faced and the aspects of care that were unsatisfactory.
02
Provide any relevant details to support your concern. This can include dates, times, names of staff members involved, and any documentation or evidence you have.
03
Clearly articulate what you believe should have been done differently or what improvements you suggest for the future to address the quality of care issue. This can include specific suggestions for changes in policies, procedures, staff training, or any other relevant aspect of care delivery.
04
If applicable, mention any attempts you have made to address the concern directly with the involved healthcare provider or facility. State whether you received a satisfactory response or if the issue remains unresolved.
05
Include your contact information, such as your name, phone number, and email address, so that the recipient of the concern can reach out to you if further information is needed.
Who needs quality of care concern?
01
Patients or individuals who have received healthcare services and believe there were issues with the quality of care they received.
02
Family members or caregivers who have concerns about the quality of care given to their loved ones.
03
Advocacy groups or organizations that work to improve healthcare quality and patient safety.
04
Healthcare providers or facilities who value feedback and are committed to continuous quality improvement.
Note: It is important to follow any specific guidelines or procedures provided by the healthcare facility or organization when filling out a quality of care concern form.
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