Survey - CMA-OMSS Hospital Well-Being Committees

California Patient Protection and Physician Health, Inc. (CPPPH), is the organization founded by the California Medical Association, the California Hospital Association, California Psychiatric Association, and California Society of Addiction Medicine to meet the needs of the medical community that are no longer filled by the Medical Board of California’s Diversion Program. CPPPH’s efforts are directed toward establishment of the ideal physician health program in California—one whose components assist all in the medical community in the efforts to maintain the health of physicians as an element of patient protection.

CPPPH is launching regional educational meetings for hospital medical staff committees on the well-being of physicians and others involved in physician health activities.

Please provide the following information about your hospital well-being committee. This information will be kept confidential and will be used only to provide your medical staff with information about available physician well-being resources.

Question Title

* Hospital Name:

Question Title

* Hospital Well Being Committee -- Chair Name:

Question Title

* E-mail:

Question Title

* Telephone:

Question Title

* Term Start Date:

Question Title

* Term End Date:

Question Title

* Years Served as Well-Being Committee Chair?

Question Title

* Hospital Well-Being Committee - Staff Name:

Question Title

* E-mail:

Question Title

* Telephone:

Thank you for participating in this survey. If you have any questions, please contact CPPPH at CPPPHInc@gmail.com.