Patients and Family Members
Health System is interested in forming a partnership with people who have experienced high quality care, satisfactory care that could have been improved or unsatisfactory care. All are eligible to apply. Persons who do and do not have health insurance are equally eligible to apply. Please download the form, fill it out, save it and return it to the email address on the form.
Health System Community Partners
Community partners are equally eligible to apply regardless of job title or rank. Please download the form, fill it out, save it and return it to the email address on the form.
Eligibility Requirements
The following eligibility requirements apply for all PFAC members:
- The commitment to actively support the purpose of the PFAC and achieve its objectives
- The commitment to regularly attend PFAC meetings, which will be two to three hours in length
- Agreement to take the immunizations required by Health System to protect the health of Health System patients, PFAC members and Health System staff and visitors
- Agreement not to disclose confidential information given to you as a member of PFAC
- Willingness to actively participate in PFAC projects, committees or working groups and be responsible for accomplishing their goals
PFAC members are expected to participate in meetings and on various committees or projects that will require a varied number of hours. If appointed to PFAC, you will serve a 24-month commitment. Read more about the committee in English and Spanish.