Lake County Medical Society

MEDIATION COMMITTEE OF THE LAKE COUNTY MEDICAL SOCIETY

As a public service to the people of Lake County and to the patients of Lake County Medical Society members, a Mediation Committee has been established to maintain quality medical care and improve physician-patient relationships in this community. If you have a concern, question or complaint regarding the care you have been provided by a member of the Lake County Medical Society, we encourage you to personally discuss the issues with your doctor before filling out the form below. Such discussions generally resolve most problems. If, however, you cannot come to a mutually understanding regarding the matter in questions, all members of the Lake County Medical Society have agreed to allow the Mediation Committee to help. We ask that you send us a letter describing the problem. Please send along a signed copy of the following authorization. We must receive an original signature on the authorization, so please print a copy of the following form and mail it to us along with your letter to:

LCMS Mediation Committee

PO Box 103

 Wickliffe, OH  44092

If you have a complaint against a physician who is not a member of the Lake County Medical Society, please contact the Ohio State Medical Board, 77 S. High St., 17th Floor, Columbus, Ohio 43215 (phone (614) 466-3934) for information on how to proceed.

THE AMERICAN MEDICAL ASSOCIATION PATIENT BILL OF RIGHTS

I. The patient has the right to receive information from physicians

and to discuss the benefits, risks and costs of appropriate treatment

alternatives.

II. The patient has the right to make decisions regarding the health care

that is recommended by his or her physician.

III. The patient has the right to courtesy, respect, dignity, responsiveness

and timely attention to his or her needs.

IV. The patient has the right to confidentiality.

V. The patient has the right to continuity of health care.

VI. The patient has a basic right to have available adequate health care.

Mediation Committee Proceedings Authorization

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