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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
No
What is your relationship to Rocky Mountain Care?
(Required)
Employee
Former Employee
Contractor
Vendor / Supplier
Resident / Patient
Family member of Resident / Patient
Friend of Resident / Patient
Family member of Employee
Other Health Care Provider
Applicant
Prospective Resident / Patient
Other
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
Email
Phone
Best time to contact if necessary
8 a.m. to noon
Noon to 5 p.m.
Preferred contact method:
E-mail
Mail
Phone
SMS / Text
Tell us about the issue:
Location:
Date of incident or situation:
MM slash DD slash YYYY
Department(s) involved:
Where you the person who experienced this incident?
Yes
No
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
Email
This field is for validation purposes and should be left unchanged.
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Our Services
Assisted Living Facilities
Chronic Care Management
Emergency Pendants
Home Health
Hospice
Outpatient Therapy
Palliative Care
Personal Care
Physician Services
Skilled Nursing & Rehabilitation
About
Careers
Contact
Bill Pay