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General Information - Pennsylvania Patient Safety Authority

General Information - Pennsylvania Patient Safety Authority 2026

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The document is a Research Billing Visit Form for the University of Pennsylvania Health System, designed to be attached to test or procedure requisition forms. It collects patient information, study account details, and contact information for the principal investigator and study personnel. The form requires clinician authorization and provides instructions for faxing to relevant scheduling and registration departments.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name in the designated field. Ensure accuracy as this is crucial for identification.
Fill in the date of birth (DOB) using the format mm/dd/yyyy. This helps in verifying patient information.
Input the Medical Record Number (MRN) if applicable, which aids in tracking patient records efficiently.
Provide appointment details including date and time, ensuring you select AM or PM correctly.
List any requested research tests or procedures clearly to avoid confusion during processing.
Complete the study account information by entering the principal investigator's name and IRB protocol number accurately.
Finally, ensure all contact information is filled out, including email and phone numbers for follow-up communications.

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2009	4.8 Satisfied (115 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who can report patient safety events?

Anyone can file a patient safety confidentiality complaint.

What is the phone number for University of Pennsylvania patient information?

Patients should share their plan with Hospital of the University of Pennsylvania Cedar Avenue staff. Please call 215-748-9100 to learn about our current visitor policy and ways to stay connected to your loved one.

Who is accountable for patient safety?

In a just culture, both the organization and its people are held accountable while focusing on risk, systems design, human behavior, and patient safety.

What is PA PSRs?

The Pennsylvania Patient Safety Reporting System (PA-PSRS) is a secure, web-based system that permits healthcare facilities to submit reports of serious events and incidents as defined by Act 13 of 2002, Act 30 of 2006, and Act 52 of 2007.

Why is patient safety event reporting important?

A safety event helps identify vulnerabilities and safety gaps within systems that allow errors to occur that can impact patients. Safety reporting prompts corrective action to improve care and patient safety.

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How does the patient safety authority use event reports?

PSA analyzes the data collected in PA-PSRS to identify trends and recommend changes in healthcare practices and procedures that may be instituted to reduce the number and severity of future serious events and incidents.

How does reporting safety incidents contribute to improving overall patient safety?

For organizations that are striving to improve patient safety, incident reports are a valuable tool for safety leaders to identify and investigate conditions that may lead to errors or cause harm.

General Information - Pennsylvania Patient Safety Authority 2026

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