Compliance - Rocky Mountain Care

This report will be kept confidential in accordance with the Compliance Program's procedures and subject to government laws.

Non-retaliation Policy: Rocky Mountain Care policy prohibits retaliation against individuals who report activities that may violate the laws, regulations and facility policies. This includes former as well as current officers, employees, contractors and volunteers. Each report is taken seriously and thoroughly reviewed to make sure proper action is taken.

Anonymity Policy: Rocky Mountain Care policy provides for compliance reports to be made anonymously. While giving your name will be helpful if more information is needed, you are not required to include it.

Do you wish to remain ANONYMOUS for this report?(Required)

Yes

What is your relationship to Rocky Mountain Care?(Required)

The person filing this complaint is:

(Do not provide this information if you wish to remain anonymous)

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Best time to contact if necessary

Preferred contact method:

E-mail

Mail

Phone

SMS / Text

Tell us about the issue:

Location:

Date of incident or situation:

Department(s) involved:

Where you the person who experienced this incident?

Yes

Other person(s) involved:

Please describe what happened with as much detail as possible.

Have you contacted the facility to try to resolve the issue? If so, what was the outcome?

What would you consider to be a proper solution to this issue?

Thank You
Again, this report will be kept confidential in accordance with the Compliance Program's procedures and subject to government laws. Upon submittal this report will be directed to the Corporate Compliance Officer at Rocky Mountain Care, LLC, Woods Cross, UT 84010

Corporate Compliance & Privacy Officer
Rocky Mountain Care, LLC

This field is for validation purposes and should be left unchanged.

Rocky Mountain Care does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities. Rocky Mountain Care does provide financial assistance of charity care based on available resources for those who cannot afford care. Individuals with financial needs should contact the Administrator to make application for charitable care. Additional resources may also be available through the Rocky Mountain Care Foundation. Donations are accepted to help fund charitable care at all Rocky Mountain Care facilities. Admission to Rocky Mountain Care facilities is based on the clinical judgment of the physician and not upon the patient’s financial ability or inability to pay for services. As a registered 501(c)(3) charitable organization, donations may be tax deductible.