Patient & Family Advisory Committee (PFAC)

Patient & Family Advisory Committee (PFAC) will develop and facilitate plans to improve safety and experiences for future patients at St. Anthony Regional Hospital.

St. Anthony is in the process of forming a Patient & Family Advisory Committee. The purpose of this committee is to receive input from patients and/or family members of patients regarding patient/family healthcare needs, suggestions to improve services, safety, and quality experience.

We are actively seeking seven potential 'advisors' from the community, St. Anthony administration, and quality members to apply to serve a one-year term. Once selected, PFAC will meet quarterly beginning in January 2023. The committee will then help to develop and facilitate a plan to improve safety and experiences for future patients. Through this committee, we hope to strengthen the link between St. Anthony and the communities we serve.

We thank you for your kind consideration.

You may complete the electronic application below or click HERE to print the application and mail to the address indicated.

APPLICATION FORM [ PATIENT | FAMILY ADVISORY COMMITTEE ]

All fields marked with * are required.

Applicant Information

LAST Name *

FIRST Name *

MIDDLE Initial

Today's Date *

Mailing Address *

City *

State *

Zip Code *

Email Address *

Primary Phone Number: *

What is your preferred contact method? *

MORE ABOUT YOU!

My experience with St. Anthony in the past has been as (check all that apply):

Patient
Family Member of Patient
Neither

Please check if you are you able to commit to a ONE hour meeting every THREE months? *

What time of the day works best for you to attend a meeting? (Choose all that apply.) *

Mornings
Afternoons
Evenings

Please check if you can serve as an advisor for at least ONE year? *

Do you have any experience as an advisor, volunteer or public speaker? Please describe:

Why are YOU in interested in being a patient|family advisor at St. Anthony Regional Hospital?

Can you describe specific things healthcare professionals at St. Anthony Regional Hospital have done to help you or your loved ones? *

Can you describe specific things healthcare professionals at St. Anthony Regional Hospital can do differently to be more helpful to you or your loved ones? *

What positive improvements to patient care would you like to see as a result of your involvement with the Patient|Family Advisory Committee?