EmailMeForm
Concern/Complaint Report
As an accrediting agency, CAMTS focus is on safety and quality patient care. The purpose of this form is to document a concern or complaint about an accredited service. Although we cannot serve as complaint mediators, we can use the information you provide to identify possible noncompliance with our standards.
When a concern or complaint is received, the completed report will be forwarded to the appropriate Board members for follow-up. Individuals completing the form will receive verification that the form was received but follow-up actions by the Board of Directors will be at the discretion of the Board. All information regarding this report is considered confidential and the source of the complaint is not revealed. CAMTS is not a regulatory agency! Matters of billing, insurance, payment disputes and personnel or labor relations are not within the scope of CAMTS. In addition, patient care and safety issues that involve federal, state, and local regulations should be reported to the appropriate authority by the complainant.
Date of submission
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Date the incident occurred
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Name of the Medical Transport Service
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City and State of Programs home base
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Concern: Please describe in detail (including when, where etc.) your complaint or concern in the space below. Please reference the accreditation standard you are referencing in the complaint such as (03.01.01 5. a.). Standards are free downloads on this website.
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Contact Info
You may remain anonymous. However, we will be unable to follow-up with questions, if necessary, as we investigate the complaint with this service.
Name
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Last
Email
Phone
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