Hospitals: Essential Community Partnership Report Form

To assist the Washington State Hospital Association with our advocacy efforts for the 2013 legislative session, we are interested in learning about your visits with legislators. Information about a legislator’s position on legislation and general comments is critical to WSHA’s advocacy efforts on behalf of your organization. This form should be completed and returned after each visit with a legislator.

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* 1. Hospital/Health System Name

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* 2. Name of Person Completing the Form:

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* 3. Legislator/Legislative Staff Attendees

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* 4. Hospital/Health System Attendees

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* 5. Meeting Location:

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* 6. Meeting Date:

Please enter the date of your meeting

Date

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* 7. Topics Covered in Meeting:

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* 8. Important Comments Made by Legislator (For example, negative comments about hospitals or health care issues, opinions about any topic covered in the campaign packet or specific legislation.):

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* 9. WSHA Follow-up Needed:

Please contact Cassie Sauer, Senior Vice President, Advocacy and Government Relations by e-mailing cassies@wsha.org with any questions or comments about your visits.

Thank you for taking the time to complete this form.