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Lecture – Appraisal Form
Please enable JavaScript in your browser to complete this form.
Which organization are you with?
*
SELECT FROM DROPDOWN
Florida Atlantic University
Florida International University
Florida State University
UF Health Shands
University of Florida – Gainesville
University of Florida – Jacksonville
Florida Academic Healthcare Patient Safety Organization (FAH PSO)
University of South Florida
If "Other":
Which SIP staff member(s) delivered the lecture? (Please select all that apply)
*
Beth W. Munz, Esq., CPHRM
Brian Boelens, Esq.
Brian Hunt, CPCU, AIC
Cheri A. Stuart, RN, JD
Daniel J. D’Alesio Jr., Esq.
George L. Rodriguez
Jennifer Miller-Louw, Esq., CPHRM
Kathryn R. Mackey, Esq.
Kevin D. Dewar, Esq.
Michelle Chastain
Randall C. Jenkins, Esq.
Tanner Cole, JD, RNC-OB, CPHRM
Other
If "Other":
Date / Time of Lecture
*
Date
Time
What was the topic of the lecture?
*
SELECT FROM DROPDOWN
Alternative Dispute Resolution
Apology and Disclosure
Defending Your License
Depositions
Disclosure of Unanticipated Outcomes
Documentation
End of Life Issues
Informed Consent
Liability and Medical Malpractice
Medical Error Prevention
Patient Safety Act
SIP 101: New Employee Orientation
SIP Grand Rounds
Other
If "Other":
Lecture Venue
*
SELECT FROM DROPDOWN
In Person
Zoom
Other
On a scale from 1 - 5, with 5 being Excellent, how would you rate the lecture?
*
Please provide comments to support your ranking above. What did you like the most? How can we be better?
*
Name
First
Last
Phone Number (optional)
Email (optional)
Submit
This webpage, Lecture Requests, is managed by Lynette Belforti, Operations & Underwriting Officer.
Please feel free to contact her for any questions or recommendations regarding page content.
