Filing Of Feedback:
Please use this page to file feedback regarding services rendered
by any discipline of The ALARIS Group. We must have feedback
in writing in order to respond appropriately. You will receive
notification of this e-mail form upon our receipt within 48 hours,
and will be contacted to verify the content of the information
by our Manager of Service Quality. Once verified, we will respond
to you within 10 days with information on how we have responded
to your feedback. You have the right to file for a grievance
if you are not in agreement with the outcome. Upon request, a
Grievance Form will be provided to you with the process outlined,
including how to appeal the final decision of the grievance.
By completion of this form, I affirm that all information is
true and correct to the best of my knowledge. I understand that
all information provided by me in connection with this feedback
may be reviewed and used by designated ALARIS staff for purposes
of grievance decisions, staff development, and quality improvement.
I also understand that ALARIS will keep this information confidential,
except for designated staff, attorney, and/or potentially a governing
jurisdictional body. I understand that I will be called upon
to clarify, verify, and/or testify on the submitted information.
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If your feedback is intended for an ALARIS employee,
please provide his/her name:
Comments:
My association to ALARIS is that of:
Injured Worker
Insurer
Employer
Attorney
Other
First Name:
Last Name:
Phone:
Email:
Physical Address:
City:
State:
Zip: |
With hitting the SEND button, you are indicating
you have authored the above; and have read and fully understand
the terms applied. |
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This information will be used to
improve ALARIS and not be used for
disciplinary action or rewards
to the specific case manager. See Privacy
Policy
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