Thank you for your interest in joining a Johns Hopkins Medicine Patient and Family Advisory Council! Council members are essential partners in JHM's mission to provide excellent patient- and family-centered care.
Please fill out this secure form to apply. Fields highlighted yellow or marked with a * are required.   
Johns Hopkins Medicine (JHM) Patient and Family Advisory Council (PFAC) Volunteer Application
Placement Preferences: Please mark your area of interest. If you do not see the PFAC you are applying for, please be sure you have selected the correct JHM Organization above.*
If you have any questions, feel free to contact us at amb_mdregion@jh.edu.
Placement Preferences: Please mark your area of interest. If you do not see the PFAC you are applying for, please be sure you have selected the correct JHM Organization above.*
If you have any questions, feel free to contact us at patientfamilycouncil@jhmi.edu.
Placement Preferences: Please mark your area of interest. If you do not see the PFAC you are applying for, please be sure you have selected the correct JHM Organization above. *
Contact Information
Education
Emergency Contact
Care Experience
I am/was (check all that apply)*
My care is/was provided by (check all that apply)*
Where did you receive your care? (check all that apply)*
The dates of my active experience at JHM include (check all that apply) *
Within the past two years, what care services have you or your family members used? (Check any that apply). We are looking for our Council members to have a range of experience with Johns Hopkins Medicine, and appreciate your sharing any information. Please be assured that this information is private and will be maintained as CONFIDENTIAL*
Within the past two years, what care services have you or your family members used? (Check any that apply). We are looking for our Council members to have a range of experience with Johns Hopkins Medicine, and appreciate your sharing any information. Please be assured that this information is private and will be maintained as CONFIDENTIAL.
Council Information
Times when you are able to engage in PFAC work (check all that apply)*
Times when you are able to engage in PFAC work (check all that apply)*
How did you hear about PFAC?*
I would be interested in helping with (identify all of your interest areas)*
I would be interested in helping with (identify all of your Ambulatory interest areas)*
Confidentiality Agreement
Click here to download the Confidentiality Statement
Final Steps
If you know other individuals who have experienced care at Johns Hopkins Medicine and may be interested in serving on the council, please share our information.

CONFIDENTIALITY: All information contained in this form is considered confidential and is intended for use by a Johns Hopkins Medicine Patient and Family Advisory Council Membership Committee. The Committee will maintain appropriate and confidential handling of personal information as stated in HIPAA guidelines and is presented in volunteer training. Qualified applicants will be selected to participate in a face-to-face interview. If selected, all Patient and Family Advisory council applicants must complete volunteer service requirements as assigned by the Volunteer Services department. These volunteer requirements include, but are not limited to the completion of the following: volunteer application, reference and criminal background check, volunteer orientation, HIPAA training and badge identification.

All patients and families served by Johns Hopkins Medicine are welcome to apply for membership as a Patient and Family Advisor.

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