Physician-Led Quality Improvement - Intake Form
Deadline : May 29th 2017, 4pm PT; For help contact : amber.hay@vch.ca

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Email address *
Contact name *
Your answer
Contact phone *
Your answer
Contact email *
Your answer
Other contact email
Your answer
Community Of Care *
Required
Program/Department *
Your answer
1. What are you trying to accomplish and why?(250 WORDS)Please provide the problem or need to be addressed and a description of what you are trying to accomplish, by the project. *
Your answer
2. How does your idea align with your department/program/division/community of care goals and priorities? *
Your answer
3. What level of commitment are you able to provide? (select all that apply). Disclaimer : there is a monthly meeting/training as part of this process. *
Required
4. What is you level of interest & involvement in Quality Improvement work? *
5. How did your hear about this initiative?
Your answer
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