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Patient/Representative Grievance Form

Any patient and/or patient representative has the ability to file a grievance as part of the patient rights process.  Patients and/or representatives filing a grievance will not be subjected to retaliation and/or barriers to service. 

Patients and/or their representatives will receive information about the procedure to use when filing a grievance with the hospital, the Office of Health Facility Licensure and Certification, and The Joint Commission.  Patients and/or patient representatives can also file a complaint regarding quality of care, disagreement with a coverage decision, or wish to appeal a premature discharge through KEPRO (Quality Improvement Organization).

Once a grievance is submitted through the use of the form below, a Patient Advocate will contact you to collect additional information.  The Patient Advocate will then meet with the Grievance Committee and you will receive a response within 7 days.  If the issue requires additional time, you will receive a response within 30 days of the filed grievance.

Thank you for taking the time to share your concerns.  We are committed to making sure our patients and their families are satisfied with the care and services they receive at Highland-Clarksburg Hospital.  If you need any further assistance, please contact the Patient Advocate at 304-969-3133 or the Highland-Clarksburg Hospital Compliance Line at 304-969-3199.

Please fill out the form below and click submit

Thanks for submitting!

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