Policy No. 61
Form 61C
STEPHEN F. AUSTIN STATE UNIVERSITY
SCHOOL OF NURSING
STANDARDS COMMITTEE REPORT
PEER REVIEW REPORT – FORM C
Date: __________________
To: __________________________________________________
The Standards Committee (Peer Review Committee) of the School of Nursing of Stephen
F. Austin State University met on ______________________________ to
consider a complaint made against _____________________________________.
__________ It is the opinion of the committee that there was no deficiency in care
attributable to the nurse.
__________ It is the opinion of the committee that there was a deficiency in care
attributable to the nurse based on the nurse’s judgment, knowledge, training, or skill.
**********
__________ The committee recommends no corrective action against the nurse.
__________ The committee recommends the following corrective action against the
nurse:
**********
__________ The committee recommends no formal disciplinary action be taken against
the nurse.
__________ The committee finds the nurse has engaged in conduct reportable to the
Texas Board of Nursing Examiners and will report such conduct in accord with the law.
You may file a written rebuttal, if you wish, and return it to the committee chairman
within ten (10) calendar days:
Committee Chairman: ______________________________________________
______________________________________________
______________________________________________
______________________________________________