Behavioral Health Depression Collaborative: January 22nd Meeting

1. Behavioral Health Depression Collaborative: January 22nd Meeting

Behavioral Health Depression Collaborative
Date: Friday, January 22, 2010
Registration & Refreshments: 12:30 p.m. to 1:00 p.m.
Session Time: 1:00 p.m. - 5:00 p.m.

Best Western Bandana Square, 1010 Bandana Blvd West, St. Paul MN
Roundhouse Conference Room

Collaborative Objective
To form a behavioral health professional community collaborative to share best practices, processes, workflows, and tools to improve outcomes for depressed patients throughout Minnesota.

Who Should Attend
Each attending team is required to have: clinical champion, administrator who oversees agency/clinic operations and resources, and quality champion. Others recommended to attend include clinical providers, data/IT designee, and other operational staff.

If you are attending with a team, please register each team member separately. For registration questions, please contact (651) 642-1903.

*
1. Attendee First Name

Attendee First Name

*
2. Attendee Last Name

Attendee Last Name

*
3. Organization Name

Organization Name

*
4. What is your role on the team? (e.g. clinical champion, administrator who oversees agency/clinic operations & resources, or quality champion)

What is your role on the team? (e.g. clinical champion, administrator who oversees agency/clinic operations & resources, or quality champion)

*
5. Attendee Email Address:

Attendee Email Address:

6. Address:

Address: Organization
Address 1
Address 2
City, State Zip

*
7. Daytime Phone Number:

Daytime Phone Number:

Behavioral Health Depression Collaborative: January 22nd Meeting

1. Behavioral Health Depression Collaborative: January 22nd Meeting

*1. Attendee First Name

*2. Attendee Last Name

*3. Organization Name

*4. What is your role on the team? (e.g. clinical champion, administrator who oversees agency/clinic operations & resources, or quality champion)

*5. Attendee Email Address: