SCAND RD Database: Instructions for Use

The purpose of the RD Database is to help connect RDNs/DTRs across South Carolina with resources available through SCAND. By filling out this survey, you are gaining access to the state-wide Mentorship Program, volunteer and preceptorship opportunities, and resources to learn more about insurance and Medicaid reimbursement opportunities. Thank you for your dedication to the health and safety of South Carolinians!

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* 1. First and Last Name

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* 2. Please list your credentials.

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* 3. Work number:

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* 4. Cell number:

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* 5. Email:

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* 6. Physical address including city, state and zip:

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* 7. County:

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* 8. Employer:

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* 9. Area(s) of interest: (check all that apply)

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* 10. Do you have an interest in volunteering at the state level?

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* 11. Are you interested in being an internship preceptor?

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* 12. Are you interested in being a mentor in our state-wide Mentorship Program?

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* 13. Are you interested in being a mentee in our state-wide Mentorship Program?

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* 14. Please select up to 3 areas of practice if you answered yes to question 12 and/or 13.

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* 15. If you are in private practice do you accept Medicaid?

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* 16. If you do not accept Medicaid are you interested in learning how to enroll?

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* 17. If you are in private practice do you accept private insurance?

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