We recognize that families are essential to every patient’s health and well-being and are important partners for high quality and safety. With Patient & Family Centered Care, family members become even more essential to the care continuum and care-giving team. That’s why we are seeking patients and families who want to share their perspective and work with our leadership team to make a lasting impact on the communities we serve.
In partnership with you, we aim to increase team awareness about patients’ and families’ choices; provide a place and time to develop creative, cost-effective solutions; and provide a patient-family perspective on changes in your healthcare experience.
Please complete the following application to the best of your knowledge in order to be considered for a voluntary position as one of our advisors or council members.
We will review your application and contact you if you have been selected to participate. If you have any questions regarding the Patient & Family Centered Care program or this application process, please call (606) 408-8056.
What is the best way to contact you?
When is the best time to contact you?
Are you currently enrolled in school or will you be during the next 12 months?
If yes, where?
Your education status:
Highest level completed:
Are you currently employed?
Current or most recent employer:
Are you available:
Please indicate how often you will be available:
Please indicate your area of interest:
If "Other" please describe
Time of your last Inpatient Hospitalization:
Family Care Center Visit:
When was your last Family Care Center Visit?
Urgent Care Visit:
When was your last Urgent Care Visit?
Specialist (check all that apply):
Did you have tests performed or become involved in any of the following (check all that apply):
When was your last Specialist Visit?
When was your last King's Brook Life Care Center Visit?
When was your last King's Daughters Medical Transportation Ambulance Visit?
Why would you like to serve as a Patient & Family Centered Care advisor? Please describe the strengths you feel you will bring to the program.
How comfortable do you feel stating your ideas, opinions and discussing differences with other families, staff and in a group?
If you were talking to a group of doctors, administrators, and nurses how would you describe a day in the life (yours or your family member) in terms of your medical needs. Think about what you would want them to know so that they can see your family's world outside of the hospital.
In your opinion, what would present the toughest challenge in your role as a Patient & Family Centered Care advisor?
Do you enjoy leadership roles or do you prefer assisting the person in charge?
What would you do to guarantee that the information you hear and discuss as a Patient & Family Centered Care advisor remains confidential?
What are some of the specific things that healthcare professionals can do to help you and your family?
List some examples of organizations or committees you have been a member of and some examples of the teaching or public speaking you have done in the past.
Please discuss any reason that would prevent you from serving as a Patient & Family Centered Care advisor on a consistent basis or might limit your ability to fulfill your role?