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كن رائدًا في سلامة المرضى
Be a Patient Safety Pioneer
Personal Information
First Name:
(Required.)
Last Name:
(Required.)
Primary Email Address:
(Required.)
Alternate Email Address (if any):
Phone Number:
(Required.)
Region:
(Required.)
Riyadh
Makkah
Madinah
Qassim
Eastern Province
Asir
Tabuk
Hail
Northern Borders
Jazan
Najran
Al Baha
Al Jouf
City of Residence:
(Required.)
Gender:
(Required.)
Male
Female
Professional Information
Name of the Organization You Work For:
(Required.)
Type of Organization:
(Required.)
Hospital
Governmental Health Authority or Regulatory Body
University
Other (please specify)
Sector You Belong To:
(Required.)
Government Sector
Private Sector
Non-Profit Organization
Professional Specialty:
(Required.)
Current Job Title:
(Required.)
Initiative-Related Questions
Why do you want to be a Patient Safety Pioneer?
(Maximum 100 words)
(Required.)
What contributions do you believe you can make as a Patient Safety Pioneer?
(Maximum 100 words)
(Required.)
Do you have any prior experience or projects related to patient safety? If yes, please provide details.
(Maximum 100 words)
(Required.)
Do you have the capacity and time to actively participate in this initiative?
(Required.)
Yes
No
Are you willing to take on additional responsibilities in the field of patient safety?
(Required.)
Yes
No
From your perspective, what are the most significant challenges in patient safety?
(Maximum 100 words)
(Required.)
Do you have any suggestions for improving patient safety in healthcare facilities?
(Maximum 100 words)
(Required.)
Do you have any other comments or feedback you would like to share?
(Maximum 100 words)
(Required.)