Joint Commission Connect -

/ Report a Complaint about a Health Care Organization

Health Care Organization Information

Complete the three steps below. In step 3, only health care organizations accredited/certified by The Joint Commission are included in the list.

1. Select the state/country	2. Select the city where the	3. Select the health care organization where the
where the incident occurred:	incident occurred:	incident occurred:

If you DID NOT find the name of the health care organization from the list in step 3 above or the address below is incorrect, Press and please complete the information below.

Type of Organization:
Organization Name:*Required
Country:
Organization Phone Number:
Organization Street Address:
City:
State:
Zip Code:

Personal Information

Complete the information below if you would like The Joint Commission to notify you about any action taken on

your complaint. Your name will be kept confidential.

I am: *Required
Do you wish to remain anonymous? *Required	Yes No
May we contact you if we need more information related to the incident? *Required	Yes No
Salutation:
First Name:
Middle Initial:
Last Name:
Suffix:
Professional Credentials:
Street Address:
City:
State:
Zip:
Telephone:		Ext:
Fax:		Ext:
Email:
Your Company Name:

Incident Information

Incident Date:

*Required

Incident Narrative (Provide a brief overview of your complaint. Please limit your narrative to 3 pages (15,000 characters)) *Required

Disclaimer (Please read the disclaimer before submitting your complaint)

When submitting a complaint to The Joint Commission about an accredited organization, you may either provide your name and contact information or submit your complaint anonymously. Providing your name and contact information enables The Joint Commission to inform you about the actions taken in response to your complaint, and also to contact you should additional information be needed.

It is our policy to treat your name as confidential information and not to disclose it to any other party. However, it may be necessary to share the complaint with the subject organization in the course of a complaint evaluation.
Joint Commission policy forbids accredited organizations from taking retaliatory actions against employees for having reported quality of care concerns to The Joint Commission.