2017 Medical Review Board Nomination Form
Heartland Kidney Network/ESRD Network 12
This nomination is for a three-year term of elected office on the Medical Review Board of ESRD Network 12, covering the states of Missouri, Kansas, Iowa and Nebraska.
• Term begins January 1, 2018
• Term Ends December 31, 2020
The Medical Review Board (MRB) is the primary working committee of Heartland Kidney Network. The MRB members use their expertise to advise the Network on clinical questions, quality improvement activities and grievance resolution.
The deadline to submit nominations is Friday, November 24, 2017.
1. I would like to be nominated in the following category:
(choose one option only):
Nephrologist-Kansas (1 position open)
Dialysis Nurse (1 position open)
Administrator (1 position open)
Dialysis Technician (1 position open)
2. As a nominee, please include a personal statement, briefly stating your reasons for seeking election to the MRB. Be sure to include information on your current position, credentials, and work experiences.
To complete the nomination process, please upload your CV or resume.
You may also email your CV or resume to Debbie Ulm, ESRD Program Manger, Heartland Kidney Network, at email@example.com
Send me a copy of my responses
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