Corporate Compliance Reporting Form - Adventist Health
Corporate Compliance Reporting Form
This report will be kept confidential in accordance with the Compliance Program's procedures and subject to government laws.
Non-retaliation Policy: Adventist Health policy prohibits retaliation against individuals who report activities that may violate the laws, regulations and facility policies. This includes former as well as current officers, employees, contractors and volunteers. Each report is taken seriously and thoroughly reviewed to make sure proper action is taken.
Anonymity Policy: Adventist Health policy provides for compliance reports to be made anonymously. While giving your name will be helpful if more information is needed, you are not required to include it.
The person filing this complaint is:
(Do not provide this information if you wish to remain anonymous)
First Name
Last Name
Address Line 1
Address Line 2 (optional)
City
State
Zip Code
E-mail address
Daytime phone number
Alternate phone number
Preferred contact method:
E-mail
Mail
Phone
What would be the best time for us to call? -Please select a timeWhat would be the best time for us to call? -Please select a time-
Tell us about the issue:
Facility: -Select a locationDate of incident or situation:
Clinic Name:
Department(s) involved:
Were you the person who experienced this incident? Yes No
Other person(s) involved:
Please describe what happened with as much detail as possible.
Have you contacted the facility to try to resolve the issue? If so, what was the outcome?
What would you consider to be a proper solution to this issue?
Thank You
Again, this report will be kept confidential in accordance with the Compliance Program's procedures and subject to government laws. Please submit this report to your supervisor, local compliance officer or the Corporate Compliance Officer at Adventist Health, P.O. Box 619002, Roseville, CA 95661-9002 OR via email at corpcomp@. Thank you for reporting this issue to us. We make every effort to review reported issues within one (1) business day to determine the best course of action.
Kevin Longo Corporate Compliance & Privacy Officer Adventist Health
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- job shadow orientation information adventhealth
- corporate compliance program adventist health
- 2019 community health needs assessment
- medical staff and allied health professional advanced
- claims era payer list march 13 2020
- accessing the hub outside the adventist health system
- corporate compliance reporting form adventist health
Related searches
- corporate financial reporting pdf
- incident accident reporting form pdf
- adventist health employee health plan
- adventist health employee health reedley
- corporate compliance best practices
- adventist health corporate office
- director corporate compliance job description
- corporate compliance officer job description
- examples of corporate compliance issues
- compliance reporting in healthcare
- corporate compliance and ethics
- corporate compliance responsibilities