Your Rights and Responsibilities
This document- Provides you with your Rights and Responsibilities relating to your surgery
- Describes how to file a grievance, if desired
- Provides information concerning physician ownership of our center
- Sets forth our center’s policy with respect to advance directives.
Patient Rights and Responsibilities Form
Click the link below to read our Nondiscrimination Notice:
Nondiscrimination Notice
Report a Patient Safety or Quality of Care Event
Do you have a patient safety event or concern about a health care organization?
How do you file a concern?
- Online:
Submit a new patient safety event or concern: https://apps.jointcommission.org/QMSInternet/IncidentEntry.aspx
Submit and update to your incident (You must have your incident number): https://apps.jointcommission.org/QMSInternet/IncidentUpdate.aspx
Submit via Medicare.gov: https://www.medicare.gov/claims-appeals - Email: patientsafetyreport@jointcommission.org
- Fax: 630-792-5636
- Mail: Office of Quality and Patient Safety
The Joint Commission
One renaissance Boulevard
Oakbrook, Illinois 60181