Complaints Grievances - Excel by axf14849

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									                                                                                                        Complaints Grievances




Patient Name   Date Received   Date Acknowledged   Description of Complaint/Grievance   Primary Area of Concern   Secondary Area of Concern   Who Does the Grievance Involve   Immediate Danger
                                                                                                 Complaints Grievances




Protection of Grievant   Investigative Steps   Update to patient of investigation   Description of Outcome               Grievance Resolution   Resolution to Patient
                                         KDQOL-36


Survey Tool   Patient Name   Date admitted
                                                KDQOL-36


Date of Initial Assessment (within 4 mos of initiating treatment)   Results
                                          KDQOL-36


Psychosocial Action Plan   Significant Life Changes   Reassessment
                                            KDQOL-36


Update Pscyhosocial Action Plan   Change in Health Status   Reassessment
                                         KDQOL-36


Update Psychosocial Plan   Date of Annual Reassessment   Results
                           KDQOL-36


Update Psychosocial Plan
                                          CAHPS


Patient Name   Date Admitted Date Administered Nephrologists Satisfaction
                                                     CAHPS


Quality of Care Satisfaction   Patient Information Satisfaction   Facility Action Plan

								
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