NOTE: This form must be fully completed and submitted to the Privacy Officer. The form can be emailed, sent by postal service, or dropped off at Redlands Community Hospital's Reception Desk. Please direct this form to the Redlands Community Hospital Privacy Officer. Name of the Reportee: Are you the patient? YesNo If not patient, relationship: Reportee's Telephone Number(include area code): Reportee's Email: Please describe your concern in detail. Be sure to mention what occurred,where and when it occurred,who was involved andhow did you learn about it: This form will be sent to the Privacy Officer and a copy to the email address supplied above.
This form will be sent to the Privacy Officer and a copy to the email address supplied above.
