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Health mediation
Fill in the professional and contact details needed for further clarifications and choose the level of confidentiality you want.
Select the report type and present the context of the case, the institution involved, and the essential elements that explain how the reported situation occurred.
Mark the observed consequences and explain the effects on the beneficiary, the community, or your professional activity.
Note what types of evidence or supporting materials already exist and may support the internal review of the case.
Mention the institutions already contacted and the current stage of discussions or the responses received so far.
Choose the form of support you consider useful for continuing the case or protecting your professional activity.
Confirm that the information is true and your agreement for processing the data for the purpose of reviewing the report.