Our goal is to meet or exceed your expectations for your care. If you have comments or concerns about the care you have received, contact Derek Lee at email@example.com. We will do our best to assist you. If you would like to report your concerns to a state or federal representative, you may contact:
- Your applicable state Dept. of Health
- bCenters for Medicare & Medicaid Services Quality Improvement Organization 800-589-7337; 216-447-9604 (Medicare Patients Only)
The Hope Institute complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Hope Institute does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
If you believe that The Hope Institute has discriminated on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Derek Lee, firstname.lastname@example.org, 1070 Commerce Dr., Building One, Suite #101, Perrysburg, OH 43551. You can file a grievance in person or by mail or email.
You can also file a civil rights complaint with the U.S. Department of Health & Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Dept. of Health & Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019; 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html