WA State Perinatal Substance Use Disorder Quality Initiative Commitment

WA State Perinatal Substance Use Disorder Quality Initiative Commitment

We are seeking an indication of your hospital’s intent to engage with the Washington State Hospital Association (WSHA) on the Washington State Perinatal Substance Use Disorder Quality Improvement Initiative. Please take a moment to complete our form. We hope you will join us in this exciting new work.

Your Name

Your Title

Your Email Address

Your Organization in Washington

Select

OB Nursing and OB Physician Lead Information

Please provide the names of your OB Nursing and OB Physician Leads so we can reach out to them with additional project details.

OB Nursing Lead First and Last Name

OB Nursing Lead Email Address

OB Nursing Lead Title

OB Physician Lead First and Last Name

OB Physician Lead Email Address

OB Physician Lead Title

Additional Team Members

Suggested team members include Social Worker, Quality Improvement specialist, Data staff, Case Worker, Discharge Planner, etc. To add additional team members now, please cut and paste this link in your URL to complete the form: https://app.smartsheet.com/b/form/4d2f674797b94f9a9166cc2ea32bd9d9

Your Commitment to WSHA and WA DOH

I intend to participate

I need more information before I participate.

We will follow-up with you to help answer additional questions.

Send me a copy of my responses

Privacy Notice|Report Abuse