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Providers: Tell Us about Patient Safety
As the Star researches patient safety, we will need help and guidance from health providers. With your permission we may contact you to help point us in the right direction.
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* Indicates required question
Last name
Your answer
First name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Type of facility where you have worked
*
Ambulatory surgical center
Clinic
Hospital
Nursing home or other facility for the aged
Rehab
Public health
Pharmacy
Regulatory
Other
Other:
Type of expert or provider
*
Choose
Administrator
Doctor
Nurse
Tech
Regulator
Pharmacist or pharmacy tech
Case manager
Other healthcare executive
Other
Please explain your area of expertise
*
Your answer
What do you think we should investigate?
*
Your answer
Have you seen any promising efforts to mitigate patient harm?
Your answer
Is it okay if we contact you for advice?
*
Yes
No
Required
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