Phoenix GME Feedback

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Type of Feedback

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Issue Type:

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Program*

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Positive Experience Report

Negative Learning Experience Report

Is this feedback about a learning experience or feedback about a person?*

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Name of the person of this feedback is about

Role of the person this feedback is about

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Mistreatment Report

Because of the incident type chosen you will be required to include your name to this submission.

All submissions are anonymous. The only party that your contact information will be shared with is the GME ombudsman and the appropriate OIE or Banner HR, offices as necessary.

The University’s Office of Institutional Equity (OIE) is responsible for reviewing and, where appropriate, objectively investigating complaints of discrimination and harassment in accordance with the Nondiscrimination and Anti-harassment Policy.

Reports of such conduct submitted through the GME Feedback Form will be immediately directed to OIE and Banner HR.

Patient Safety Concern

If you need to report a patient safety event, instead of using this form, please follow these instructions:

•B-UMCP: Open the relevant patient record in PowerChart, select “mPages” on the left sidebar menu, and then select the top option of “A Safety Event Submission”.

• VA: Submit a confidential Joint Patient Safety Reporting (JPSR) system entry on the VA Phoenix intranet homepage.

Date of the Event (optional)

Educator Name (if applicable)

Has this situation already been discussed with the individual?

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Details about discussion

Tell us more about the discussion, so that we can assist further.

Description

Positive Feedback Type

Treats others with dignity and respect

Demonstrates exemplary collaboration

Creates an environment that values diversity, equity and inclusion

Demonstrates concern for student/trainee wellness

Outstanding Mentor/Scientist/clinician/Educator

Send an MVP

Click this box if you would like your feedback to be sent as An MVP, Banner's Recognition Program.

We invite you to recognize and celebrate colleagues using MVP, This systemwide recognition platform designed to provide a way for you to recognize and celebrate our Most Valuable People.

Action

Standard Work Flow

Urgent

Request action only if similar reports exist

What is your involvement in this experience?

Directly Involved

Who should be alerted?

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Would you like to discuss this in more detail?*

Yes

What is the best way to contact you?*

Phone

Phone Number

Phone

Email Address

Your name*

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Submission Number*

Create a submission number and save it for future reference. This number will be the identification number for your feedback.

Example - your mom's birthday, digits from your home phone number or old address, something only you know and that you can recall.

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