SSM Health Patient Concern/Compliment Form 2018-2025 free printable template

PATIENT CONCERN / COMPLIMENT Formation:_ ___Date_of_Birth:_ ___ Address:_ ___Phone:___ ___Account_#:_ ___ City_ State_ Zip Provider/Clinic:___ Date(s)_of_Service:_ ___Concern/Compliment ___ ___ ___

How to fill out SSM Health Patient ConcernCompliment Form

How to fill out SSM Health Patient Concern/Compliment Form

1. Visit the SSM Health website or obtain a physical copy of the Patient Concern/Compliment Form.
2. Fill in your personal information including name, contact number, and email address.
3. Indicate whether your submission is a concern or a compliment.
4. Provide specific details about your concern or compliment, including dates, locations, and staff involved.
5. Be clear and concise while describing your experience.
6. Review the form for any errors or missing information.
7. Submit the form either online or by mailing it to the designated address.

Who needs SSM Health Patient Concern/Compliment Form?

1. Patients who have experienced a concern or wish to provide a compliment about their care at SSM Health.
2. Family members or guardians of patients wanting to advocate for a loved one’s experience.
3. Individuals who want to share feedback to improve the quality of care in the organization.

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What is SSM Health Patient Concern/Compliment Form?

The SSM Health Patient Concern/Compliment Form is a document that allows patients to report their concerns or compliments regarding the care and services they received at SSM Health facilities.

Who is required to file SSM Health Patient Concern/Compliment Form?

Any patient, family member, or representative who has feedback about their experience at SSM Health, whether it is a concern or a compliment, is encouraged to file the form.

How to fill out SSM Health Patient Concern/Compliment Form?

To fill out the SSM Health Patient Concern/Compliment Form, individuals should provide their contact information, describe the concern or compliment in detail, and submit it according to the instructions provided on the form.

What is the purpose of SSM Health Patient Concern/Compliment Form?

The purpose of the SSM Health Patient Concern/Compliment Form is to gather feedback from patients to improve services, address concerns, and recognize staff for exemplary care.

What information must be reported on SSM Health Patient Concern/Compliment Form?

The information that must be reported includes the patient's contact details, the nature of the concern or compliment, relevant dates, and any specific details about the incident or experience.