IMPROVE THE PATIENT AND FAMILY EXPERIENCE

Our Patient Family Advisory Councils (PFAC) in partnership with UT Health San Antonio were created to help improve the quality of our health system’s care for all patients and families. These councils provide patients and their families an opportunity to share their experiences with hospital administration, other patients and their families to improve the delivery of care.


PFAC members are volunteers who graciously dedicate their time. PFAC members commit to:

• Meet monthly with our leadership, physicians and other patients and families

• Work as a team and share experiences

• Provide honest feedback

• Respect the perspectives of others

• Educate leadership and staff

• Help enhance the patient and family experience


COUNCILS FOR DIFFERENT TYPES OF CARE

We have PFACs available for multiple forms of care. Let us know your interest and experience so we can find the right council for you.


Please complete the PFAC application form. Once you complete the form, click the submit button at the bottom.


Name and Address

Fill in your full legal name below. This information will ensure the accuracy of processing your application.



Demographics

Our Volgistics database has security measures in place to keep your information safe.




Referral Source

How did you learn about the Patient Family Advisory Council (PFAC)? Please name the referral source.



PFAC Involvement

Would you be able to commit to 2 hours per month to attend meetings?



PFAC Involvement

Are you able to commit to becoming a committee member and completing group projects?



Council Interest

Why do you want to become a member of PFAC? What topics/issues would you like to see the Patient Family Advisory Council address?



Additional Information

Have you or your family received care at University Health? If yes, please explain in the space below.



Contact in Case of Emergency


PFAC Committee

Volunteer opportunities vary dependent on time and location based on the PFAC commitment. Please select the PFAC committee for participation. Meetings are held in the evenings monthly or quarterly.



Skills

Please check skills which you would be willing to share as a volunteer with University Health PFAC.



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however we will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Application Disclosure

Your date of birth is requested only for the purpose of obtaining a consumer report. Your response to the requested information is voluntary, and refusal to provide the information will not subject you to any adverse treatment. Your assistance in providing the information on this form will be greatly appreciated and will be kept confidential. Please be advised that this form will be separated from, and is not a part of, your official application for volunteer acceptance.


Note: A consumer report may consist of employment records, education verification, licensure verification, driving history,previous address, and other public records relative to criminal charges. A credit report will not be requested unless it is deemed pertinent to the functions of the position for which you are applying.


I have read the above notice and understand what it means. I hereby authorize the procurement of a consumer report for volunteer purposes. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report may be made in connection with your application for acceptance.


If you are denied, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer reporting agency making such report. You will also receive a copy of the report and a statement of your consumer rights.




PFAC Application Acknowledgement

I HEREBY CERTIFY that all the information provided on this application is true, correct and complete. I grant University Health permission to verify this information for the purpose of determining my volunteer acceptance. I understand any misrepresentation or omission of any facts necessary to make this application complete shall be cause for rejection of the application or dismissal by University Health.


I understand this application is not intended as a job offer or a contract for any specific time period and that I may resign or be terminated at any time without notice or requirement of cause.


I understand and agree that, as a condition of acceptance, I will be required to successfully complete all acceptance requirements. I further agree to abide by all rules, regulations, and policies of University Health if accepted. I understand any acceptance is contingent upon successful completion of background check and health screening. I understand, if accepted, I will be required to complete an annual health screening.


Notice of Controlled Substance and Nicotine Testing Policy:

University Health conducts its operations with the highest possible degree of safety for acceptance. Because of this standard, University Health requests that all final candidates for acceptance undergo screening for controlled substances and nicotine.


The screening for controlled substance and nicotine will not be performed without the written, signed consent of the volunteer. A volunteer who decides not to submit to a screening for controlled substances and nicotine, or who does not successfully complete this screening, will not be further considered for acceptance.


By clicking I Agree, I am accepting the conditions and requirements as stated in the Volunteer Acknowledgement and Application Disclosure statements listed above.