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Creation of a PA Maternal Health Collaborative
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1.
Name
(Required.)
2.
Title
3.
Organization(s) or Group(s) You are Representing
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4.
Email Address
(Required.)
5.
What part of Pennsylvania does your group represent or serve?
Northwest PA
Southwest PA
Lehigh/Capital PA
Northeastern PA
Southeastern PA
Statewide
If it is at the county or neighborhood-level, please indicate that here.
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6.
Please briefly describe your maternal and perinatal health group, including its current work.
(Required.)
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7.
What is your group's
1st recommended priority
to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.
(Required.)
8.
What is your group's
2nd recommended priority
to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.
9.
What is your group's
3rd recommended priority
to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.
10.
What name would you suggest for this statewide Collaborative? Please feel free to suggest more than one name!