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PFAC

Thank you for taking the time to complete this application for Lake Cumberland Regional Hospital’s (LCRH) Patient and Family Advisory Council (PFAC).
The PFAC will comprise current and former patients, family members, and clinical staff of LCRH. The council will meet to collaborate on enhancements in patient safety, quality, and experience.
The goals of the council are:
• Provide insight to hospital leaders and staff about patient and family healthcare needs
• Work with staff to improve patient and family services
• Improve patient safety, quality and experience
• Serve as a patient family advisor working with us in the planning of patient care areas and patient programs
The benefits of joining the PFAC include:
• Being part of a team
• Making a difference in the lives of our patients, family, and staff
• Meeting new people who have had similar experiences as yours
The Patient and Family Advisory Council will meet at lunchtime in the odd months of the year at LCRH.

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* 1. Name

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* 2. Address

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* 4. Phone

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* 5. How did you hear about PFAC?

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* 6. What days are you usually available? (Select all that apply.)

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* 7. Why would you like to be a member of the Patient Family Advisory Council?

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* 8. What would you like us to know about you?

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* 9. What are your areas of interest?

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* 10. How do you know about the hospital?

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