NW1 - 2018 Improve Transplant Coordination Quality Improvement Activity (QIA) - Key Facility Staff Contact Information |
QIA Key Staff Contact Information Form
Please provide the name, phone number, and email address of the project lead, back-up project lead, and any other supporting contacts in your organization via the form below by February 2, 2018.
Instructions:
Instructions:
- Populate all fields.
- If the contact requested in a specific job title question is the same as the project lead or back-up project lead, enter "Same as project lead" or "Same as back-up project lead" in the name, phone number, and email address fields.
- If your facility does not have corresponding personnel in a specific job title, enter "N/A" in the name, phone number, and email address fields.
- Completion is dependent on all fields being completed.