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What Can We Do To Serve You Better?
Guardian Hospice Care wants you to receive high quality care. We work hard to
see that you get what your doctor orders, when you are supposed to get it. That is not only the law but our professional responsibility and the least to which you are entitled. We also want you to recognize our concern for how you feel about the care you are getting. If you have a concern or complaint, we want you to tell us right away.
If you have a problem with the care you are receiving please call the Administrator at (318) 484-4418 or 1-866-909-2315.
If you would rather write it down, please take some time to do so in the space provided below and mail this form to:
Administrator
Guardian Hospice Care, L.L.C. 5212 Rue Verdun
Alexandria, LA 71303
CONFLICT RESOLUTION REQUEST
Patient Name: ............................................................... Telephone#: ............................ Date You Became Concerned: ...................................... Today’s Date: .......................... Problem/Concern: .......................................................................................................... ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ Signature: ....................................................................................................................... Relationship to Patient:..................................................................................................
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