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Note: Please use this form only for questions related to Safety, Quality and/or the Improving Patient Care (IPC) Program. If you are a patient, please contact a patient representative at your local facility, or if you are on staff at a health care facility.
We would really like for you to share your questions with us in the Quality Portal.
Note
To protect you, your family's, or your patient's privacy, please DO NOT include any Personally Identifiable Information (PII) or Protected Health Information (PHI) on this form.
Examples of PII and PHI are: personal phone number(s), personal address, individual health condition(s), Social Security number (SSN), date of birth (DOB), patient name (if not your own), and patient registration number.
For more information regarding PII and PHI, please visit the Privacy Policy and HIPAA pages.
