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Shared Learning for Integrated Care Programs


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Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)
Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)

Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)

Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care
Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care

Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care

List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)
List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)

List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)

How would you describe your area of focus: (check as many as apply)
How would you describe your area of focus: (check as many as apply)

How would you describe your area of focus: (check as many as apply)

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