Request Access to the Patient Safety Learning Center

Full Name

First NameLast Name

Work E-mail

Work Phone Number

Area CodePhone Number

Are you positioned at a DoD Military Treatment Facility (MTF)?

Please select your MTF from this list.

Country

State

Please describe your need for a PSLC account.

What is the name and title of the person who referred you to the DoD PSLC?

What is your primary job title?

Do you provide Medical or Dental Services?

To what organization do you belong or provide support?

What is your status?

To which Service do you belong?

Which of these applies most specifically to your status?

What company employs you?

DoD Patient Safety Learning Center

Terms of Use

1. I agree to notify the PSLC Support Team within 10 business days if any of my personal/professional information changes that may affect my account eligibility.

2. I will not grant access to or allow any third party to use my PSLC account.

3. I will not copy or distribute information contained on the PSLC to persons not sponsored by the DoD PSP.

4. I may be granted access to content that is private and/or Title 10 USC Section 1102 protected quality assurance information based on eligibility requirements defined by the managing PSLC Administrator, Patient Safety Service Representative, or PSP Leader.

5. I agree to maintain in confidence, all confidential information and protected data. I will only disclose it to those with a need to know and with the understanding that such information shall be kept confidential, as defined by TITLE 10, Subtitle A, PART II, CHAPTER 55, Section 1102, Confidentiality of medical quality assurance records: qualified immunity for participants.

*The PSLC Terms of Use may change without notice.

*The DoD PSP reserves the right to terminate sponsorship of your PSLC membership.

I have read the DoD PSLC Terms of Use and agree not to share any protected information, in accordance with US Code Title 10, Subtitle A, Part II, Chapter 55, Section 1102.