Houses of worship/religious organizations Patient satisfaction surveys Promotional efforts within institution to patients or families Promotional efforts within institution to providers or staff Recruitment brochures Word of mouth/through existing members Other (Please describe): N/A we did not recruit new members in FY 2018 – 8. Total number of staff members on the PFAC: 9. Total number of patient or family member advisors on the PFAC: 10. The name of the hospital department supporting the PFAC is: 11. The hospital position of the PFAC Staff Liaison/Coordinator is: 12. The hospital provides the following for PFAC members to encourage their participation in meetings (check all that apply): Annual gifts of appreciation Assistive services for those with disabilities Conference call numbers or meeting” options “virtual Meetings outside 9am-5pm office Parking, mileage, or meals Payment for attendance at annual PFAC conference Payment for attendance at other conferences or trainings Provision/reimbursement for child care or elder care Stipends Translator or interpreter services Other (Please describe): N/A Section 3: Community Representation The PFAC regulations require that patient and family members in your PFAC be of the “representative community served by the hospital.” If you are not sure how to answer the following questions, contact your community relations office or check know.” “don’t 13. Our hospital’s catchment area is geographically defined as: Don’t know 14. Tell us about racial and ethnic groups in these areas (please provide percentages; if you are unsure of the percentages check know”): “don’t RACE ETHNICITY % % % % % % % American Black or Native White Other Hispanic, Indian or African Hawaiian Latino, or or other
Houses of worship/religious organizations Patient satisfaction surveys Promotional efforts within institution to patients or families Promotional efforts within institution to providers or staff Recruitment brochures Word of mouth/through existing members Other (Please describe): N/A – we did not recruit new members in FY 2018 8. Total number of staff members on the PFAC: 9. Total number of patient or family member advisors on the PFAC: 10. The name of the hospital department supporting the PFAC is: 11. The hospital position of the PFAC Staff Liaison/Coordinator is: 12. The hospital provides the following for PFAC members to encourage their participation in meetings (check all that apply): Annual gifts of appreciation Assistive services for those with disabilities Conference call numbers or “virtual meeting” options Meetings outside 9am-5pm office Parking, mileage, or meals Payment for attendance at annual PFAC conference Payment for attendance at other conferences or trainings Provision/reimbursement for child care or elder care Stipends Translator or interpreter services Other (Please describe): N/A Section 3: Community Representation The PFAC regulations require that patient and family members in your PFAC be “representative of the community served by the hospital.” If you are not sure how to answer the following questions, contact your community relations office or check “don’t know.” 13. Our hospital’s catchment area is geographically defined as: Don’t know 14. Tell us about racial and ethnic groups in these areas (please provide percentages; if you are unsure of the percentages check “don’t know”): RACE ETHNICITY % American Indian or % % Black or African % Native Hawaiian or other % White % Other % Hispanic, Latino, or
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