S02 - Attachment D Priority Patient Concern Form.docx

This file is an image of a Priority Patient Concern Form template for use in the Great Lakes Region Durable Medical Equipment (DME) Delivery Services solicitation. The form appears to be a blank template designed to capture and document patient concerns or complaints related to DME delivery services provided through the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12. As an attachment to the solicitation documents, this form serves as a standardized tool for collecting feedback and reporting issues from patients receiving DME services under this contract. The specific fields and detailed structure of the form cannot be fully determined from the image provided, but it functions as an appendix to establish consistent procedures for handling and recording patient concerns throughout the contract performance period.