American Diabetes Association: Survey - ERP Q/A Call Submission

ERP Q/A Call Submission

1.

Question - Not Required - Are you currently an ADA Recognized Service team member?

Yes

No

2.

Question - Not Required - Program ID If Currently Recognized (optional):

3.

Question - Not Required - If you are not currently a team member of an ADA Recognized Service, do you plan to apply for ADA Recognition in the future?

Yes

No

*4.

Question - Required - Are you the Quality Coordinator?

*5.

Question - Required - Your Name:

*6.

Question - Required - Email Address

*7.

Question - Required - Which Q/A Call would you like to attend?

	Application & Annual Status Report Q/A
	New Quality Coordinator Q/A
	Chronicle Diabetes Q/A
	DPP Express Q/A
	DSME & DSMES Q/A
	CMS Audit Preparation Q/A