SHS PI Leadership Forum
First Name
*
Last Name
*
Job Title
Organization
Email Address
*
How many direct reports do you have?
0-1
2-5
5-15
15+
Do you work with a patient facing organization?
YES
NO
What type of organization?
Hospital/Health System
Medical Practices
Outpatient Services
Other
What would you like to gain from participating?
Which topics would be interested in discussing?
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