PRE-ADMISSION FORM (Hospital Patients Only)

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Patient Relations

Our goal is to provide the best patient care. If at any time you have questions or concerns about the quality of care that you or a family member are receiving or have received at our Hospital, do not hesitate to speak with your nurse or any of the following options:

a.  You have the right to express concerns about your care by first speaking to your physician or the staff caring for you. If the issue is not resolved to your satisfaction, you may contact the charge nurse or dial “0” for the operator and ask to speak to the House Supervisor.

b.  You may also express written grievance by submitting in writing your concerns to the above mentioned staff or to the President/CEO of the Hospital:

Wayne HealthCare

835 Sweitzer Street, Greenville, Ohio 45331.

 

c.  If not resolved to your satisfaction, you have the right to file a complaint by contacting:

Ohio KePRO Medicare Beneficiary Helpline at (800) 589-7337

or

Centers for Medicare and Medicaid at http://www.cms.gov/ or by calling (800) 633-4227

or

Ohio Department of Health, Provider and Consumer Services Unit, at www.odh.ohio.gov or by calling (800) 342-0553