Elliot Lake Family Health Team Patient Advisory Council Membership Application

                                                                                                                                          

 

Name:  _________________________

 

Phone Number:  _________________

 

Email:  _________________________

 

 

 

Elliot Lake Family Health Team Patient Advisory Council

Membership Application

 

 

The ELFHT is seeking informed patients and family members/caregivers to participate in a Patient Advisory Council (PAC).  The purpose of the PAC is to advise the ELFHT leadership on issues affecting patient care and provide feedback on our programs and services.

 

An ideal candidate would be someone who is passionate about health care, is in touch with our local patient community and can provide objective feedback on ELFHT programs and services.

 

Please answer the following questions to the best of your ability.  You may be contacted if we need any clarification.  Those who are selected as members of the PAC will be contacted directly.  Thank you for your interest!

 

1. Please explain what specifically interests you about participating in the PAC.

 

 

 

2. Is there a particular project that you would like the PAC to work on in the coming year?


 

3. What skills or patient/caregiver perspective do you bring that you think would benefit the PAC?

 

 

 

4. The PAC is a volunteer-based group.

a) Are you committed to attending four meetings a year?

 

 

b) Are you willing to do work in between meetings (reading, providing feedback to things sent out by email)?

 

 

c) Do you think you might have time to help out with working groups/special projects, in addition to the regular PAC meetings?

 

 

5. Please list below all of the providers/services/programs that you and/or the family member you are representing has accessed at the ELFHT.