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If you are interested serving on Primary Care’s Patient Advisory Council for a minimum of 1 year, please complete this application and turn it in to the Front Desk.

P.A.C. Member Qualifications:Telluride Regional Medical Center Administration in consultation with Primary Care will nominate and select the members of the Council based on the following qualification:

1. Must have been a patient of Telluride Regional Medical Center-PC for the past 24 months and had at least 2 visits per year during that time at a
minimum.
2. Commit to a 1 year term and able to attend 75% of the meetings in person.
3. Should be respectful of others and a positive collaborative individual that can interact well in a group in a
constructive manner.
4. You will not be alone so members must be able to see beyond their own personal experience and not have a
particular axe to grind.
5. It is not necessary to have a medical background but should be somewhat familiar with how healthcare works.
6. Able to listen well and consider other’s point of view.
7. Have no reservations about signing a HIPAA agreement to protect all sensitive data and discussions they may
come across in the course of being a member on the PAC.
8. Highly consider individuals who have had positive feedback to the practice in the past.