Consultant Qualifications Registry

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* 1. Please complete the following form and e-mail an updated Curriculum Vitae (CV) and writing samples (in English and Spanish) to info@impactivo.com.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country

Email Address:

Phone Number:

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* 2. Preferred Method of Contact

E-mail

Phone

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* 3. Areas of Research and/or Work Interests

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* 4. Publications, Articles, and/or Books Written

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* 5. Relevant Past and/or Current Research Projects Performed (Topic, Year(s) )

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* 6. Current and Past Consulting Engagements - if applicable (Client, Year, and Type of Deliverable i.e. feasibility study, strategic plan, needs assessment, etc)

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* 7. Areas of Individual Specialization and/or Consulting Skills: Level of Expertise

	Expert	Extensive Knowledge	Some Knowledge	Little or No Knowledge
Telehealth	Telehealth Expert	Telehealth Extensive Knowledge	Telehealth Some Knowledge	Telehealth Little or No Knowledge
Patient-centered medical home	Patient-centered medical home Expert	Patient-centered medical home Extensive Knowledge	Patient-centered medical home Some Knowledge	Patient-centered medical home Little or No Knowledge
Clinical practice transformation	Clinical practice transformation Expert	Clinical practice transformation Extensive Knowledge	Clinical practice transformation Some Knowledge	Clinical practice transformation Little or No Knowledge
Implementation Research	Implementation Research Expert	Implementation Research Extensive Knowledge	Implementation Research Some Knowledge	Implementation Research Little or No Knowledge
Community-based Participatory Research	Community-based Participatory Research Expert	Community-based Participatory Research Extensive Knowledge	Community-based Participatory Research Some Knowledge	Community-based Participatory Research Little or No Knowledge
Chronic Diseases	Chronic Diseases Expert	Chronic Diseases Extensive Knowledge	Chronic Diseases Some Knowledge	Chronic Diseases Little or No Knowledge
Mental Health	Mental Health Expert	Mental Health Extensive Knowledge	Mental Health Some Knowledge	Mental Health Little or No Knowledge
Maternal/Child Health	Maternal/Child Health Expert	Maternal/Child Health Extensive Knowledge	Maternal/Child Health Some Knowledge	Maternal/Child Health Little or No Knowledge
Quantitative Research Methods	Quantitative Research Methods Expert	Quantitative Research Methods Extensive Knowledge	Quantitative Research Methods Some Knowledge	Quantitative Research Methods Little or No Knowledge
Qualitative Research Methods	Qualitative Research Methods Expert	Qualitative Research Methods Extensive Knowledge	Qualitative Research Methods Some Knowledge	Qualitative Research Methods Little or No Knowledge
Econometrics	Econometrics Expert	Econometrics Extensive Knowledge	Econometrics Some Knowledge	Econometrics Little or No Knowledge
Financial Modeling	Financial Modeling Expert	Financial Modeling Extensive Knowledge	Financial Modeling Some Knowledge	Financial Modeling Little or No Knowledge
Quality Improvement	Quality Improvement Expert	Quality Improvement Extensive Knowledge	Quality Improvement Some Knowledge	Quality Improvement Little or No Knowledge
Policy Analysis	Policy Analysis Expert	Policy Analysis Extensive Knowledge	Policy Analysis Some Knowledge	Policy Analysis Little or No Knowledge
Program Development	Program Development Expert	Program Development Extensive Knowledge	Program Development Some Knowledge	Program Development Little or No Knowledge
Interpersonal Communications	Interpersonal Communications Expert	Interpersonal Communications Extensive Knowledge	Interpersonal Communications Some Knowledge	Interpersonal Communications Little or No Knowledge
Client Management	Client Management Expert	Client Management Extensive Knowledge	Client Management Some Knowledge	Client Management Little or No Knowledge
Organizational Assessment	Organizational Assessment Expert	Organizational Assessment Extensive Knowledge	Organizational Assessment Some Knowledge	Organizational Assessment Little or No Knowledge
Performance Improvement	Performance Improvement Expert	Performance Improvement Extensive Knowledge	Performance Improvement Some Knowledge	Performance Improvement Little or No Knowledge
Process Consultation	Process Consultation Expert	Process Consultation Extensive Knowledge	Process Consultation Some Knowledge	Process Consultation Little or No Knowledge
Strategic Planning	Strategic Planning Expert	Strategic Planning Extensive Knowledge	Strategic Planning Some Knowledge	Strategic Planning Little or No Knowledge
Team Building	Team Building Expert	Team Building Extensive Knowledge	Team Building Some Knowledge	Team Building Little or No Knowledge
Review of Internal Controls	Review of Internal Controls Expert	Review of Internal Controls Extensive Knowledge	Review of Internal Controls Some Knowledge	Review of Internal Controls Little or No Knowledge
Compliance Review	Compliance Review Expert	Compliance Review Extensive Knowledge	Compliance Review Some Knowledge	Compliance Review Little or No Knowledge
Biostatistics	Biostatistics Expert	Biostatistics Extensive Knowledge	Biostatistics Some Knowledge	Biostatistics Little or No Knowledge
Program Evaluation	Program Evaluation Expert	Program Evaluation Extensive Knowledge	Program Evaluation Some Knowledge	Program Evaluation Little or No Knowledge
Feasibility Studies	Feasibility Studies Expert	Feasibility Studies Extensive Knowledge	Feasibility Studies Some Knowledge	Feasibility Studies Little or No Knowledge
Federal Proposal Writing	Federal Proposal Writing Expert	Federal Proposal Writing Extensive Knowledge	Federal Proposal Writing Some Knowledge	Federal Proposal Writing Little or No Knowledge
Best Practices Benchmarking	Best Practices Benchmarking Expert	Best Practices Benchmarking Extensive Knowledge	Best Practices Benchmarking Some Knowledge	Best Practices Benchmarking Little or No Knowledge
Communications	Communications Expert	Communications Extensive Knowledge	Communications Some Knowledge	Communications Little or No Knowledge
Epidemiology	Epidemiology Expert	Epidemiology Extensive Knowledge	Epidemiology Some Knowledge	Epidemiology Little or No Knowledge
Project Management	Project Management Expert	Project Management Extensive Knowledge	Project Management Some Knowledge	Project Management Little or No Knowledge
Supervisory Skills	Supervisory Skills Expert	Supervisory Skills Extensive Knowledge	Supervisory Skills Some Knowledge	Supervisory Skills Little or No Knowledge
Systems Analysis	Systems Analysis Expert	Systems Analysis Extensive Knowledge	Systems Analysis Some Knowledge	Systems Analysis Little or No Knowledge
Scenario Planning	Scenario Planning Expert	Scenario Planning Extensive Knowledge	Scenario Planning Some Knowledge	Scenario Planning Little or No Knowledge
Training	Training Expert	Training Extensive Knowledge	Training Some Knowledge	Training Little or No Knowledge
Technical Assistance	Technical Assistance Expert	Technical Assistance Extensive Knowledge	Technical Assistance Some Knowledge	Technical Assistance Little or No Knowledge

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* 8. Knowledge on the Affordable Care Act: Level of Expertise

	Expert	Extensive Knowledge	Some Knowledge	Little or No Knowledge
Electronic Health Records	Electronic Health Records Expert	Electronic Health Records Extensive Knowledge	Electronic Health Records Some Knowledge	Electronic Health Records Little or No Knowledge
Health Information Technology	Health Information Technology Expert	Health Information Technology Extensive Knowledge	Health Information Technology Some Knowledge	Health Information Technology Little or No Knowledge
Health Insurance Exchanges	Health Insurance Exchanges Expert	Health Insurance Exchanges Extensive Knowledge	Health Insurance Exchanges Some Knowledge	Health Insurance Exchanges Little or No Knowledge
Accountable Care Organizations	Accountable Care Organizations Expert	Accountable Care Organizations Extensive Knowledge	Accountable Care Organizations Some Knowledge	Accountable Care Organizations Little or No Knowledge
Employer Health Plan Requirements	Employer Health Plan Requirements Expert	Employer Health Plan Requirements Extensive Knowledge	Employer Health Plan Requirements Some Knowledge	Employer Health Plan Requirements Little or No Knowledge
Medicare Reform	Medicare Reform Expert	Medicare Reform Extensive Knowledge	Medicare Reform Some Knowledge	Medicare Reform Little or No Knowledge
Health Quality Improvement	Health Quality Improvement Expert	Health Quality Improvement Extensive Knowledge	Health Quality Improvement Some Knowledge	Health Quality Improvement Little or No Knowledge
Medicaid & CHIP Reform	Medicaid & CHIP Reform Expert	Medicaid & CHIP Reform Extensive Knowledge	Medicaid & CHIP Reform Some Knowledge	Medicaid & CHIP Reform Little or No Knowledge
Prevention & Wellness Care	Prevention & Wellness Care Expert	Prevention & Wellness Care Extensive Knowledge	Prevention & Wellness Care Some Knowledge	Prevention & Wellness Care Little or No Knowledge
Hospital Payment Reform	Hospital Payment Reform Expert	Hospital Payment Reform Extensive Knowledge	Hospital Payment Reform Some Knowledge	Hospital Payment Reform Little or No Knowledge
Health Insurance Reforms	Health Insurance Reforms Expert	Health Insurance Reforms Extensive Knowledge	Health Insurance Reforms Some Knowledge	Health Insurance Reforms Little or No Knowledge
Medical Homes	Medical Homes Expert	Medical Homes Extensive Knowledge	Medical Homes Some Knowledge	Medical Homes Little or No Knowledge
Promotion of Primary Care	Promotion of Primary Care Expert	Promotion of Primary Care Extensive Knowledge	Promotion of Primary Care Some Knowledge	Promotion of Primary Care Little or No Knowledge
Health Care Cost Savings	Health Care Cost Savings Expert	Health Care Cost Savings Extensive Knowledge	Health Care Cost Savings Some Knowledge	Health Care Cost Savings Little or No Knowledge
Health Care Workforce Promotion	Health Care Workforce Promotion Expert	Health Care Workforce Promotion Extensive Knowledge	Health Care Workforce Promotion Some Knowledge	Health Care Workforce Promotion Little or No Knowledge
Transparency Enhancement	Transparency Enhancement Expert	Transparency Enhancement Extensive Knowledge	Transparency Enhancement Some Knowledge	Transparency Enhancement Little or No Knowledge

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* 9. Please indicate any other consulting services which you would be interested in offering:

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* 10. Please indicate your level of interest in:

	Very Interested	Somewhat Interested	Neutral	Not Very Interested	Not at All Interested
Learning about opportunities for research and consulting projects	Learning about opportunities for research and consulting projects Very Interested	Learning about opportunities for research and consulting projects Somewhat Interested	Learning about opportunities for research and consulting projects Neutral	Learning about opportunities for research and consulting projects Not Very Interested	Learning about opportunities for research and consulting projects Not at All Interested
Participating in research and consulting projects	Participating in research and consulting projects Very Interested	Participating in research and consulting projects Somewhat Interested	Participating in research and consulting projects Neutral	Participating in research and consulting projects Not Very Interested	Participating in research and consulting projects Not at All Interested

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* 11. Please indicate your availability to work on research and/or consulting engagements:

Available to work during the academic school year

Available to work during the academic recess

Both

Neither

Available full time

Available part time

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* 1. Please complete the following form and e-mail an updated Curriculum Vitae (CV) and writing samples (in English and Spanish) to info@impactivo.com.

Question Title

* 2. Preferred Method of Contact

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* 3. Areas of Research and/or Work Interests

Question Title

* 4. Publications, Articles, and/or Books Written

Question Title

* 5. Relevant Past and/or Current Research Projects Performed (Topic, Year(s) )

Question Title

* 6. Current and Past Consulting Engagements - if applicable (Client, Year, and Type of Deliverable i.e. feasibility study, strategic plan, needs assessment, etc)

Question Title

* 7. Areas of Individual Specialization and/or Consulting Skills: Level of Expertise

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* 8. Knowledge on the Affordable Care Act: Level of Expertise

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* 9. Please indicate any other consulting services which you would be interested in offering:

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* 10. Please indicate your level of interest in:

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* 11. Please indicate your availability to work on research and/or consulting engagements:

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* 12. Please, indicate Projects and/or Research that you believe are of importance for Puerto Rico and/or the World