Thank you for taking the time to share your patient safety concern or event regarding a Joint Commission accredited organization. The Joint Commission takes any information about one of our accredited organizations seriously.

   Please be aware that The Joint Commission does not evaluate the care of an individual, or whether that care was appropriate. Instead, our evaluation focuses on processes that are required within our standards. Issues related to billing, insurance or labor disputes are not within The Joint Commission Standards. We encourage you to contact the organization directly for resolution.

   Please complete the following to submit a safety concern or event regarding a Joint Commission accredited organization. (Note: if you can not locate an organization within the dropdown menu, the organization may not be accredited by The Joint Commission.)

Health Care Organization Information
1. Select the state/country *Required 2. Select the city where the *Required 3. Select the health care organization *Required
where the incident occurred: incident occurred: where the 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:*Required
Organization Phone Number:
Organization Street Address:*Required
City:*Required
State:*Required
Zip Code:*Required
You have the option to submit your safety concern or event anonymously or you may provide your personal information if you wish to know the status of your submission.
   
Complete the information below if you would like The Joint Commission to notify you about the status of your safety concern or event. Your name/identity as the source will be kept confidential.

Source Information
I am: *Required
Do you wish to remain anonymous? *Required
May we contact you if we need more information related to the incident? *Required
Salutation:
First Name:
Middle Initial:
Last Name:
Email:
Suffix:
Professional Credentials:
Street Address:
City:
State:
Zip:
Telephone: Ext:
Fax: Ext:
Your Company Name:
Incident Information
Date safety event occurred(mm/dd/yyyy): *Required
Incident Narrative: Provide a brief overview of your safety event. Please limit your narrative to 3 pages (15,000 characters). You may attach a document(s), to support your concerns, however, the Incident Narrative must be filled in first, and be submitted, in order for document attachments to be uploaded. *If you wish to upload a document, you will be able to after submission on the next page. *Required
Disclaimer/Confidentiality Waiver (Please read the disclaimer before submitting your safety concern or event)

Thank you for taking the time to share your patient safety concern. The Joint Commission is here to help organizations improve. We will use your report to better understand systems of care and guide improvement.

We will review your report and determine how best to evaluate your concerns. This could include contacting the organization about your concern.

Should we decide to contact the organization about your concern, please confirm whether you give The Joint Commission permission to:
  • Release your name as the source of this concern and share a copy of the information you have sent to The Joint Commission with the organization.
Please select one:*Required



*Disclaimer:
  • Permission to share may not result in an inquiry, but it will enable sharing your name as source and a copy of the information should The Joint Commission decide to write the organization about your concern.
  • If confidentiality is not waived, we may still act on your reported safety concerns following our established processes for anonymous reporting.
  • Please be aware that in line with our Public Information Policy, we cannot provide you with the organization’s response should an inquiry be pursued.
Thank you for bringing your concerns to our attention and helping us with our mission of continuously improving healthcare.