Acknowledgement Letter

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Acknowledgement Letter
Date:
Dear_______________________:
Thank you for bringing your concern to our attention. We take all concerns very seriously and can
assure you that your concerns will be fully investigated. It is our goal to resolve your concerns in a
manner that is satisfactory to all parties involved.
______________________ will follow up with you in in one week from the date of this letter to provide
you with an update on our investigation. We appreciate your patience in this matter. If you have any
questions please contact ____________________ at _____________________.
Please note that all patients should feel safe filing a complaint or grievance without fear of retaliation. If
you feel that are being retaliated against, please notify ___________________ immediately.
Additionally, if you feel that you have been discriminated against based on race, color, national origin,
disability, age, gender, sexual orientation, or religious beliefs you may file a complaint with the Office for
Civil Rights at 1-800-368-1019.
Kind Regards,

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