Complaint - Template

	Name
Select	CATHOLIC HEALTH INITIATIVES- IOWA CORP.
Select	DIANE CUMMINGS
Select	MERCYONE DES MOINES MEDICAL CENTER
Select	Mercy Medical Center - Des Moines
Select	MERCYONE DES MOINES MEDICAL CENTER
Select
Select	RON MUECKE
Select	RON MUECKE
Select	RON MUECKE
Select	LAURIE DICKINSON
Select	BILL STIRLER
Select	MERCY MEDICAL CENTER
Select
Select
Select
Select

Complaint ID - 12854

Mercyone Des Moines Medical Center - 311123156

1111 6TH AVE. Des Moines, IA 50314

Polk County

FO 5

Site Name:

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Complaint ID:

12854

Date Received:

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Received By:

Assigned To:

Complainant

Anonymous

DNR Observation

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(F)

(L)

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Statement of Complaint:

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Responsible Party

Report

Attached Files/Reports

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
1/3/2011	I emailed the complaint to Jeremy Becker and Brent Blanchard with Polk County Air.	BILL GROSS

Comment:

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

Multiple Results Found

Field Office Compliance - Complaint

Complaint ID - 12854

Mercyone Des Moines Medical Center - 311123156

1111 6TH AVE. Des Moines, IA 50314

Polk County

FO 5

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