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<p><strong>Join us! Together we can work to improve the care for our patients.&nbsp;</strong>The Patient and Family Advisory Council (PFAC) supports the mission of Barton Health by working to enhance and improve the patient care experience. Advisors discuss and plan changes to improve hospital quality, safety and experience. Advisor members include Barton Health patients and family members. Advisors may participate in:</p><ul><li>Sharing your story. Advisors help by talking about their health care experiences with clinicians, staff, and other patients.</li><li>Participating in committees. Advisors tell us what it&rsquo;s like to be a patient at our hospital and what we can do to improve during patient care committee meetings.</li><li>Reviewing or helping create educational or informational materials. Advisors help review or create materials like forms, health information handouts, and discharge instructions. Advisors help us make these materials easier for all patients and family members to understand and use.</li><li>Working on short-term projects. We sometimes ask advisors to partner with us in making improvements &mdash; for example, helping to plan and design a patient care cart.</li></ul>\
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                            <option value=\'\'>( Please Select )</option>\
                            <option value=\'AL\'>Alabama</option>\
                            <option value=\'AK\'>Alaska</option>\
                            <option value=\'AZ\'>Arizona</option>\
                            <option value=\'AR\'>Arkansas</option>\
                            <option value=\'CA\'>California</option>\
                            <option value=\'CO\'>Colorado</option>\
                            <option value=\'CT\'>Connecticut</option>\
                            <option value=\'DE\'>Delaware</option>\
                            <option value=\'DC\'>District Of Columbia</option>\
                            <option value=\'FL\'>Florida</option>\
                            <option value=\'GA\'>Georgia</option>\
                            <option value=\'HI\'>Hawaii</option>\
                            <option value=\'ID\'>Idaho</option>\
                            <option value=\'IL\'>Illinois</option>\
                            <option value=\'IN\'>Indiana</option>\
                            <option value=\'IA\'>Iowa</option>\
                            <option value=\'KS\'>Kansas</option>\
                            <option value=\'KY\'>Kentucky</option>\
                            <option value=\'LA\'>Louisiana</option>\
                            <option value=\'ME\'>Maine</option>\
                            <option value=\'MD\'>Maryland</option>\
                            <option value=\'MA\'>Massachusetts</option>\
                            <option value=\'MI\'>Michigan</option>\
                            <option value=\'MN\'>Minnesota</option>\
                            <option value=\'MS\'>Mississippi</option>\
                            <option value=\'MO\'>Missouri</option>\
                            <option value=\'MT\'>Montana</option>\
                            <option value=\'NE\'>Nebraska</option>\
                            <option value=\'NV\'>Nevada</option>\
                            <option value=\'NH\'>New Hampshire</option>\
                            <option value=\'NJ\'>New Jersey</option>\
                            <option value=\'NM\'>New Mexico</option>\
                            <option value=\'NY\'>New York</option>\
                            <option value=\'NC\'>North Carolina</option>\
                            <option value=\'ND\'>North Dakota</option>\
                            <option value=\'OH\'>Ohio</option>\
                            <option value=\'OK\'>Oklahoma</option>\
                            <option value=\'OR\'>Oregon</option>\
                            <option value=\'PA\'>Pennsylvania</option>\
                            <option value=\'RI\'>Rhode Island</option>\
                            <option value=\'SC\'>South Carolina</option>\
                            <option value=\'SD\'>South Dakota</option>\
                            <option value=\'TN\'>Tennessee</option>\
                            <option value=\'TX\'>Texas</option>\
                            <option value=\'UT\'>Utah</option>\
                            <option value=\'VT\'>Vermont</option>\
                            <option value=\'VA\'>Virginia</option>\
                            <option value=\'WA\'>Washington</option>\
                            <option value=\'WV\'>West Virginia</option>\
                            <option value=\'WI\'>Wisconsin</option>\
                            <option value=\'WY\'>Wyoming</option>\
                        </select>\
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                </div>\
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                    <label class=\'control-label \' for=\'FormField3_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_Zip\'>Zip<span class=\'fb-required\'>*</span></label>\
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</div></div><div class=\'form-group\'><label  class=\'control-label  \'>Are you a Barton Health<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Patient\' required data-msg-required=\'Are you a Barton Health is required.\' name=\'checkbox5\' id=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'Are_you_a_Barton_Health\' ><label for=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Patient</label></div><div class=\'separate\'><input type=\'radio\' value=\'Family member of a patient\' required data-msg-required=\'Are you a Barton Health is required.\' name=\'checkbox5\' id=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'Are_you_a_Barton_Health\' ><label for=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>Family member of a patient</label></div><div class=\'separate\'><input type=\'radio\' value=\'Both\' required data-msg-required=\'Are you a Barton Health is required.\' name=\'checkbox5\' id=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'right\' data-export-label=\'Are_you_a_Barton_Health\' ><label for=\'FormField5_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>Both</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField6_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'control-label  \'>What languages do you speak?</label><div>\
<input type=\'text\' name=\'FormField6_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' id=\'FormField6_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'form-control input-medium \' value=\'\' data-rule-maxlength=\'500\' data-msg-maxlength=\'You have exceeded the max length of 500 characters.\'  data-export-label=\'What_languages_do_you_speak\'  placeholder=\'\'  />\
</div></div><div class=\'form-group\'><label  class=\'control-label  \'>When was your most recent care experience at Barton Health?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'2020 to current\' required data-msg-required=\'When was your most recent care experience at Barton Health? is required.\' name=\'checkbox7\' id=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'recent_experience\' ><label for=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>2020 to current</label></div><div class=\'separate\'><input type=\'radio\' value=\'2015-2020\' required data-msg-required=\'When was your most recent care experience at Barton Health? is required.\' name=\'checkbox7\' id=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'recent_experience\' ><label for=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>2015-2020</label></div><div class=\'separate\'><input type=\'radio\' value=\'2010-2015\' required data-msg-required=\'When was your most recent care experience at Barton Health? is required.\' name=\'checkbox7\' id=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'right\' data-export-label=\'recent_experience\' ><label for=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>2010-2015</label></div><div class=\'separate\'><input type=\'radio\' value=\'2010 or before\' required data-msg-required=\'When was your most recent care experience at Barton Health? is required.\' name=\'checkbox7\' id=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\' class=\'right\' data-export-label=\'recent_experience\' ><label for=\'FormField7_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\'>2010 or before</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Which unit(s) provided care for you or your family member?</label><div><div><fieldset class=\'CheckboxGroup\'><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Inpatient Stay at Barton Memorial Hospital (includes ICU, Med-Surg, and Ortho units)\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Inpatient Stay at Barton Memorial Hospital (includes ICU, Med-Surg, and Ortho units)</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Family Birthing Center at Barton Memorial Hospital\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>Family Birthing Center at Barton Memorial Hospital</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Emergency Department or Urgent Care\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>Emergency Department or Urgent Care</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Primary Care\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\'>Primary Care</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Outpatient Specialty Office (such as: ENT, Orthopedics, or Urology)\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_5\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_5\'>Outpatient Specialty Office (such as: ENT, Orthopedics, or Urology)</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Outpatient Testing (Medical Imaging, Sleep Studies, or Lab)\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_6\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_6\'>Outpatient Testing (Medical Imaging, Sleep Studies, or Lab)</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Other:\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_8\' id=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_7\' class=\'fo-right-margin-5\' data-export-label=\'care_units\' ><label for=\'FormField8_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_7\'>Other:</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField17_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'control-label  \'>If other, which unit?</label><div>\
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</div></div><div class=\'form-group\'><label  class=\'control-label  \'>We recognize that our advisors have busy lives. How much time are you willing to commit to being a Patient &amp; Family Advisor?</label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Less than 1 hour per month.\'  name=\'checkbox11\' id=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'time_commitment\' ><label for=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Less than 1 hour per month.</label></div><div class=\'separate\'><input type=\'radio\' value=\'1 to 2 hours per month.\'  name=\'checkbox11\' id=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'time_commitment\' ><label for=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>1 to 2 hours per month.</label></div><div class=\'separate\'><input type=\'radio\' value=\'3 to 4 hours per month.\'  name=\'checkbox11\' id=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'right\' data-export-label=\'time_commitment\' ><label for=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>3 to 4 hours per month.</label></div><div class=\'separate\'><input type=\'radio\' value=\'More than 4 hours per month.\'  name=\'checkbox11\' id=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\' class=\'right\' data-export-label=\'time_commitment\' ><label for=\'FormField11_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\'>More than 4 hours per month.</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Are you available to serve as an advisor for at least 1 to 2 years?</label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Yes\'  name=\'checkbox12\' id=\'FormField12_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'Available\' ><label for=\'FormField12_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Yes</label></div><div class=\'separate\'><input type=\'radio\' value=\'No\'  name=\'checkbox12\' id=\'FormField12_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'Available\' ><label for=\'FormField12_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>No</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>How do you want to help? (Check all that apply.)</label><div><div><fieldset class=\'CheckboxGroup\'><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Help develop or review materials for patients and family members.\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Help develop or review materials for patients and family members.</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Help improve patient safety and the prevention of medical errors.\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>Help improve patient safety and the prevention of medical errors.</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Help improve the patient and family role in care decision making.\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>Help improve the patient and family role in care decision making.</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Help improve the hospital facilities.\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_4\'>Help improve the hospital facilities.</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Help develop patient care experience initiatives.\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_5\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_5\'>Help develop patient care experience initiatives.</label></div><div class=\'separate Chkbx\'><input type=\'checkbox\' value=\'Other\'  name=\'3353c4ab-97fe-4ac7-b9c8-34ed42183d34_FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_checkbox_13\' id=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_6\' class=\'fo-right-margin-5\' data-export-label=\'How_Help\' ><label for=\'FormField13_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_6\'>Other</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField18_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'control-label  \'>If other, how do you want to help?</label><div>\
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</div></div><div class=\'form-group\'><label  class=\'control-label  \'>Are you related to a Barton Health employee or provider?</label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Yes\'  name=\'checkbox14\' id=\'FormField14_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'Related\' ><label for=\'FormField14_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Yes</label></div><div class=\'separate\'><input type=\'radio\' value=\'No\'  name=\'checkbox14\' id=\'FormField14_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'Related\' ><label for=\'FormField14_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>No</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Have you had a positive or negative experience with Barton Health?</label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Positive\'  name=\'checkbox15\' id=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\' class=\'right\' data-export-label=\'Postive_Negative\' ><label for=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_1\'>Positive</label></div><div class=\'separate\'><input type=\'radio\' value=\'Negative\'  name=\'checkbox15\' id=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\' class=\'right\' data-export-label=\'Postive_Negative\' ><label for=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_2\'>Negative</label></div><div class=\'separate\'><input type=\'radio\' value=\'Other\'  name=\'checkbox15\' id=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\' class=\'right\' data-export-label=\'Postive_Negative\' ><label for=\'FormField15_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff_3\'>Other</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField19_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'control-label  \'>If other, what was your experience?</label><div>\
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</div></div><div class=\'form-group\'><label for=\'FormField16_a7f1148a-63aa-4e3a-a947-c0dd9ebf55ff\' class=\'control-label  \'>Please explain why you would like to participate on Barton Health&#39;s Patient &amp; Family Advisory Council?</label><div>\
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