Merger Monitor Form

Submit a Complaint

First Name

Last Name

Phone

What is the best method for the Monitor to contact you? *

Address Line 1

Address Line 2

City

State

ZIP Code

Have you shared this comment/concern/potential violation of the Equity Impact Conditions and Competitive Impact Conditions with any law enforcement agency or regulatory entity in California? *

If yes, with whom?

Hospital(s) Involved:

Rady Children's Hospital of San Diego Children's Hospital of Orange County Children's Hospital of Orange County at Mission Other

If “Other”, please provide more information.

Location(s) Involved: *

Please describe the potential violation of the Equity Impact Conditions and Competitive Impact Conditions in as much detail as possible: *

Please provide any documents, photographs, or other electronic materials you may have to help the Monitoring Team investigate the potential violation of the Equity Impact Conditions and Competitive Impact Conditions.

Please describe the files you are submitting *

In filing this complaint, I understand that my complaint, the information included in the complaint, and the documents submitted in support of my complaint may be shared with the California Attorney General’s Office, but will otherwise be confidential and not disclosed to Rady or CHOC, without my consent? *

* Indicates a required field