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Health Care Quality Concerns form
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* Type of complaint

Care: You experienced a lack of privacy during the visit. You received the wrong care or diagnosis. You sustained an injury from the treatment. The doctor or employee displayed inappropriate professional behavior.

Access: No doctor was available. Handicapped access was not available. No appointments were available to meet your need.

Service: The doctor or employee was rude. The facility was unsafe or unclean. The doctor did not spend enough time with you. You were not treated with respect.

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