Common use of Participant’s Signature Clause in Contracts

Participant’s Signature. Date: Administrative Use Only Internal Log # _ Date Received by Staff: Staff Name and Position: Grievance Type: ☐ Grievance ☐ Appeal #:4256 Attachment 3 County of Orange Health Care Agency, Office of Care Coordination Shelter Grievance Process The Shelter Grievance Process document is intended to provide Shelter Participants information on their grievance rights and an overview of the process. The County of Orange (County) appreciates feedback and takes grievances seriously. The County will work to resolve Participant grievances in a transparent and efficient manner. If you as a Shelter Participant are unsure of how to access the shelter grievance process within the shelter you are staying, you can reference the information provided during the intake process, ask a shelter staff member, or review grievance information posted in the common areas of the shelter. If at any time during the process you experience difficulty with the shelter grievance process, please reference the Contact Information in Step 3 (below) to contact the County directly via telephone, email and/or mail.

Participant’s Signature. Date: Administrative Use Only Internal Log # _ Date Received by Staff: Staff Name and Position: Grievance Type: ☐ Grievance ☐ Appeal #:4256 Attachment A Attachment 3 County of Orange Health Care Agency, Office of Care Coordination Shelter Grievance Process The Shelter Grievance Process document is intended to provide Shelter Participants information on their grievance rights and an overview of the process. The County of Orange (County) appreciates feedback and takes grievances seriously. The County will work to resolve Participant grievances in a transparent and efficient manner. If you as a Shelter Participant are unsure of how to access the shelter grievance process within the shelter you are staying, you can reference the information provided during the intake process, ask a shelter staff member, or review grievance information posted in the common areas of the shelter. If at any time during the process you experience difficulty with the shelter grievance process, please reference the Contact Information in Step 3 (below) to contact the County directly via telephone, email and/or mail.

Participant’s Signature. Date: Administrative Use Only Internal Log # _ Date Received by Staff: Staff Name and Position: Grievance Type: ☐ Grievance ☐ Appeal #:4256 Attachment 3 County of Orange Health Care AgencyExecutive Office, Office of Care Coordination Shelter Grievance Process The Shelter Grievance Process document is intended to provide Shelter Participants information on their grievance rights and an overview of the process. The County of Orange (County) appreciates feedback and takes grievances seriously. The County will work to resolve Participant grievances in a transparent and efficient manner. If you as a Shelter Participant are unsure of how to access the shelter grievance process within the shelter you are staying, you can reference the information provided during the intake process, ask a shelter staff member, or review grievance information posted in the common areas of the shelter. If at any time during the process you experience difficulty with the shelter grievance process, please reference the Contact Information in Step 3 (below) to contact the County directly via telephone, email and/or mail.

Participant’s Signature. Date: Administrative Use Only Internal Log # _ Date Received by Staff: Staff Name and Position: Grievance Type: ☐ Grievance ☐ Appeal #:4256 Attachment 3 County of Orange Health Care AgencyCounty Executive Office, Office of Care Coordination Shelter Grievance Process Attachment A The Shelter Grievance Process document is intended to provide Shelter Participants information on their grievance rights and an overview of the process. The County of Orange (County) appreciates feedback and takes grievances seriously. The County will work to resolve Participant grievances in a transparent and efficient manner. If you as a Shelter Participant are unsure of how to access the shelter grievance process within the shelter you are staying, you can reference the information provided during the intake process, ask a shelter staff member, or review grievance information posted in the common areas of the shelter. If at any time during the process you experience difficulty with the shelter grievance process, please reference the Contact Information in Step 3 (below) to contact the County directly via telephone, email and/or mail.