Parkview Community Hospital Medical Center (PCHMC) is a

193 bed licensed acute care hospital. PCHMC is accredited by

The Joint Commission both Hospital and Laboratory Services.

Survey’s are unannounced and no longer scheduled.

 

If you have a complaint or concern as a patient or

visitor, you may contact: The Clinical Manager on the

unit, or you may ask to speak to the House Supervisor

 

If this issue is not resolved then contact:

 

PCHMC Patient Relations:

951-688-2211 extension #4224.

After hours, contact the House Supervisor by dialing “0”

 

3865 Jackson Street

Riverside, CA 92503

Web address: www.pchmc.org

fax #951-352-5364

 

If you feel that your complaint or grievance was not handled to your satisfaction, you may contact:

California Department of Public Health
Riverside District Office
625 E. Carnegie Drive
Suite 280
San Bernardino, CA 92408
909-388-7170

or

Division of Accreditation Operations
Office of Quality Monitoring
The Joint Commission
One Renaissance Boulevard
Oakbrook, IL 60181
or fax to 630-792-5636
or email to complaint@jointocmmission.org

* Please note: if you are having difficulty with electronic submission of this form, you may print from your browser window and mail to:

HIPAA Security Officer
c/o Parkview Community Hospital
3865 Jackson Street
Riverside, CA 92503

 

PATIENT / VISITOR GRIEVANCE FORM

*Patient Name

Name & relationship of person filing complaint (if different from above)

*SSN# *DOB

*Address

*City/State/ZIP

*Telephone (day) *Telephone (evening)

*Date of Event(s)

*Location of Events

Name / description of person you are submitting a complaint about

*Describe the nature of your complaint - include details of event and floor or department where you were receiving service (if additional space if required, please e-mail patientrelations@pchmc.org with further details).

*By typing my name in the box below, I certify that the the above information is true and complete, to the best of my knowledge.

May we contact you if we need any additional information regarding your concern? yes / no

We appreciate your feedback and concerns. Please note that all grievances will be responded to in writing at the above address within 7 days of submission. If you have any further questions, please contact patient relations at (951) 352-5479.

(* indicates required fields)