Disclaimer Agreement - Risk Manager

TriValley Primary Care is providing the means for you to provide a report regarding serious wrong-doing (criminal or civil) by a TriValley provider or staff member. So that this may be a good experience for all concerned, there are rules to follow. To proceed further, you must agree to the following rules:

  1. I agree to read the instructions on the risk manager form. In particular, I will carefully review the purpose and limitations statements on the form.
  2. I understand and agree that the risk manager form is NOT to be used as a means of dialog (two-way contact) with a TriValley physician or office, but rather to convey information regarding a serious matter involving TriValley staff, a provider, policy, or process. If I need to speak with a physician or nurse, I will call the office.
  3. I understand that this link is NOT to be used to ask a question. I will direct my questions to the medical office I visit or the TriValley Corporate office by means of telephone or U.S. postal service mail or in person as appropriate.
  4. I agree that I will NOT use this form to request services of any kind. If I want to do this, then I shall return to the Home Page and click on the appropriate Request button, or I shall call the medical office I visit.
  5. If it is an urgent matter or an emergency, I agree to seek care at the most immediately available medical facility, including a hospital emergency room or I shall call 911, as appropriate.
  6. I agree that I will NOT use this form to make a routine comment or suggestion. If I want to do this, then I shall return to the Home Page and click on the Feedback button.

Having read and understanding all of the above, I agree to use the form for the stated purposes as shown on the form. By clicking the "I Agree" button, below, I affirm my intention to abide by the above rules.

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