Saturday, April 29, 2017
 

Patient Experience Record

The Stanislaus Medical Society (SMS) is a non-profit organization of physicians and surgeons, dedicated to maintaining quality medical care and improving patient relationships. SMS has a variety of committees volunteering their time toward these goals.

It is recommended that you personally discuss the issue with your physician before completing and returning this form. In most instances this communication resolves the problem.

If the treating physician is not an SMS member, our ability to be of service may be limited but, in the interest of improving patient relationships, we will still process your complaint. In all cases, even if the physician in questions is a member of the SMS, the opinion of the Committee will be advisory only. SMS has no power to require you or your physician to accept its advice.

ACTION: This matter will be directed to the proper committee for review. You will be advised when they have rendered an opinion. Please allow 6-12 weeks for completion of the review process.

Please download this form, complete the necessary information for our Review Committee. [please print or type] and return to the Stanislaus Medical Society at PO Box 76007, Modesto CA, 95357-6007. The more clearly you describe the situation or problem, the more effective the review can be.

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