BETA GEMS Submission Form

As BETA Healthcare Group (BETA) continues to partner with healthcare providers to manage risk, we enjoy the opportunity to celebrate the success of our members in the areas of patient safety, employee safety and risk management. BETA GEMS (Guiding Excellence through Member Sharing) is a collegial resource which highlights and catalogs both patient and employee safety best practices that have transformed BETA facilities and medical groups.

Thank you for taking the time to submit your project and/or initiative. A BETA Representative will be in touch with you to review your project and complete the submission process. Please, contact us, if you have questions at betaGEMS@betahg.com.

GEMS

Personal Information
Name*
First Last
Title
Email*
Phone*
Name of Facility*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CEO/President (name)
Risk Manager
Name
First Last
Email
Phone
Director of Quality Assurance and/or Compliance
Name
First Last
Title
Email
Phone
Facility Project/Initiative Contact 1
Name
First Last
Title
Email
Department
Phone
Facility Project/Initiative Contact 2
Name
First Last
Title
Email
Department
Phone
Other Information
BETA Representative Assigned to Account*
Name of Project*
Is this a Group Project?*
- Yes
- No
Type of Project*
- Patient Safety
- Employee Safety
Please provide a brief synopsis of the project*

GEMS

Personal Information

Risk Manager

Director of Quality Assurance and/or Compliance

Facility Project/Initiative Contact 1

Facility Project/Initiative Contact 2

Other Information