AmeriHealth Caritas Pennsylvania Community HealthChoices Provider Responsibilities Webinar

Thank you for attending the Provider Responsibilities, Critical Incident, and Enterprise Management Webinar. Please take a moment to fill out the survey below.

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* 1. Name

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* 2. Title

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* 3. Practice/organization name

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* 4. Practice/organization ZIP Code

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* 5. Plan assigned provider ID

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* 6. Tax identification number (TIN)

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* 7. Email address

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* 8. Phone number

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* 9. Additional training needs or follow-up contact by your Account Executive

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* 10. Preferred method of contact

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* 11. Comments/suggestions