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Medical Staff Member Call Contact Preferences

 

Dear Practitioner;
In November 2005 the Medical Executive Committee passed a motion that each medical staff member must have at least two contact numbers on file when on call. This will be two points of contact for all call whether EMTALA or call for when your patients present to the hospital. You may list only an Answering Service as a contact as long as the Answering Service has at least two ways to contact you.

Please provide your 1st, 2nd, and 3rd contact number below in the order you wish them to be used to contact you. The order in which they are provided will instruct the necessary individuals on how best to contact you when needed. The Medical Staff Office is responsible for updating the hospital's STAR system, which feeds Prov Port and will use the information you provide. There is space in STAR to put special instructions, please note, at this time the comments cannot be seen in Prov Port, however, it is a project MIS is working on.

At the bottom of this page e-mail information is requested. Your email address is kept confidential by the Medical Staff Office and will not be released unless permission is given by the provider. The Medical Staff Office uses email to inform physicians of upcoming department and committee meetings, the Medical Staff Newsletter, urgent health issue updates, and time sensitive news from around the hospital effecting physicians and patients.

Contact Information: 

Name:

1st Contact #:   type:

2nd Contact #   type:

3rd Contact #:   type:

Comments: - up to 144 characters
Email address:
How often do you check your email?
I prefer to receive information via email:  YES  NO

Your email is kept confidential by the MSO and will not be released without your permission.