Compliance Feedback System Step 1 of 3 - Instructions 33% Welcome to the Perfusion.com Feedback System. Please do not use the Back or Forward buttons on your browser once you have begun the alert process. Please use the Next and Previous buttons provided at the bottom of each page instead. This service is not an emergency help line. If you are reporting an emergency, please dial 911 or contact the appropriate authorities directly. You may also choose to contact the Joint Commission (1-800-994-6610) and report the event anonymously, without any disciplinary or punitive action by Perfusion.com, Inc. Before we begin, take a moment to collect your thoughts. If you wish to remain anonymous, make sure you are in a private, non-company location (such as your home, a library, etc.), and be careful to not identify yourself through your comments or files you may include with your communication. Throughout this process, try to be as descriptive and objective as possible so your communication has the best chance of resolution. The entire process normally takes about 5-10 minutes. By clicking next, I agree that I have read and agreed to Perfusion.com's Terms & Conditions and Privacy Policy. Which of the following best describes your relationship with our company?* Associate Customer Vendor Other Please select your state below.*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPlease select the category of feedback you wish to provide below.* Accounting, Auditing and Financial Falsification of Information Sabotage and Vandalism Violation of Company Policy Discrimination Quality of Care or Services Misconduct Conflict of Interest Fraud, Deceit and Embezzlement Employee Concern Unsafe Workplace Substance Abuse Violence Disclosure of Proprietary Information / Breach of Confidentiality Theft Harassment Patient Safety Please identify the person(s) involved including names and titles:* Enter at least 1 response.Do you believe that management is aware of this issue?* Yes No Uncertain When (approximately) did this issue occur?* MM slash DD slash YYYY Does this issue involve any outside parties (vendor, customer, etc.)?(please explain)Please describe the issue in detail below.*In your opinion, what would be the best way to resolve this issue?*Please enter your email address if you would like immediate follow-up. (optional)Captcha Δ
