Your Information Note: Providing contact information allows UMC Health System to contact you about actions taken in regard to your complaint, or allows us to contact you if more information about your complaint is needed. Address
Date(s) of hospital care related to complaint*
Location in hospital related to complaint (Required) Select 3 East 3 West 4 East 4 West 5 West Accounts Recovery Administration Admissions Biomedical Burn Services Cafeteria Case Management Cath Lab Cath Lab Per-op Construction Management Corporate Compliance Corporate marketing CVICU/CICU Day surgery Decision Support Education Resources Emergency Center Emergency Center Physicians Emergency Medical Services Endoscopy Center Environmental Services Family Birth Center Family Care Unit Food & Nutrition Foundation General laboratory Administration Geriatric Trauma Unit Grand Expectations Health Information Management Healthplan Operations Hemodialysis Home Health Human Resources ICCU Infection Prevention & Control IT Analytics IT Clinical Informatics IT Infrastructure Medical Intensive Care Unit Neonatal Intensive Care Unit Northstar Therapy Nurse Recruitment Nursing Support Services Operating Room Outpatient Surgery Pastoral Care Patient Accounting—coll. Patient Placement Center Pediatric Intensive Care Unit Pediatrics Performance Improvement Respiratory Therapy Revenue Integrity Safety Services Security Seniors are Special Service Development Social Services STAR Center Supportive Care Unit SWCC Administration SWCC Chemotherapy Telephone Triage Transplant Services Trauma & Burn Service Trauma and Surgical ICU TTUHSC Utilities Management Volunteers Who are you filing complaint on behalf of (Required)
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Desired Outcome (Required) Description Please provide a description of your complaint. Describe the action(s) that lead to filing a complaint and the individuals involved (Required) Supporting Documentation
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