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* 1. Name

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* 2. Agency

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* 3. What Meeting Frequency would you prefer for the Committee?

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* 4. Location of meeting?

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* 5. Meeting duration:

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* 6. Please rank your interest in the following topics. Use the up and down arrows to put your preferred topics at the top, and those you think are less relevant to the bottom.

  1. How to start a community paramedicine curriculum
  2. Development of protocols for community paramedicine, e.g., CHF and COPD
  3. Review of published research on community paramedicine
  4. Local social service connections
  5. How to get your client into nursing home/assisted living without going to a hospital
  6. Standardizing clinical documentation
  7. Home safety standard assessment
  8. Fall reduction services
  9. Substance Use Disorder services
  10. Safe sleep services for pediatric patients
  11. Software providers for community paramedicine management
  12. Sources of funding, e.g., grants, government updates
  13. Sources of funding, e.g., insurance reimbursement

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* 7. Other topics of interest in community paramedicine:

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* 8. Other topics of interest for the GMVEMSC Research Committee besides community paramedicine?

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* 9. Other comments and suggestions: