Is Your Organization Interested in Learning More about PARS® and CPPA Collaboration?

Please tell us more about your organization by completing the form below. After receiving your information, we will call or email you.

CONTACT INFORMATION

Your name and role/title

Name of organization

Mailing address

Phone number

Email address

ABOUT YOUR ORGANIZATION

About your physicians and health care providers:

How many physicians have privileges with your medical facility and/or group?

How many physicians practice independently of the institution, or hold part-time practices not affiliated with the institution/group?

About your facilities and beds:

Please list all medical facilities, their locations, and their bed count, if appropriate. Include out-of-state and "off-campus" facilities. If you have a website with this information, please include the web address (URL).

About your service recovery and patient complaints:

Who does "service recovery" in your organization (e.g. "two patient advocates in the office of patient/professional relations")?

How many unsolicited patient/family complaints are recorded each year by how many staff members?

What computer program (including version) is used to record patient/family complaints?

Can your data be transmitted via the Internet?

Through today, how many consecutive years of complaint data are available for us to screen?

BEFORE YOU SUBMIT

Please make sure your email address is correct. A copy of the submitted information will be emailed to the address you provide.
Note that the information you have provided is treated as strictly CONFIDENTIAL and will not be shared or used for purposes other than to discuss a relationship with CPPA.
Please click here if you wish to be placed on the CPPA Email List
The email address provided in the form above will be used unless you provide an alternative here:

Thank you for your interest in our work and for providing your organization's information. We will contact you, or if you prefer, you may contact:

Ruth F. Schimmel
by phone at 615-343-4500 or by email at ruth.f.schimmel at vanderbilt.edu