Behavioral Health Depression Collaborative: November 17th Meeting

1. Behavioral Health Depression Collaborative: November 17th Meeting

Behavioral Health Depression Collaborative
Date: Thursday, November 17, 2011
Registration & Coffee: 12:30 to 1:00 p.m.
Session Time: 1:00 - 5:00 p.m.

Best Western Plus at Mall of America
1901 Killebrew Drive, Bloomington, MN
Room: Regency East Ballroom

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 call (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. Organizational Address:

Organizational Address: Address 1
Address 2
City, State Zip

*
7. Daytime Phone Number:

Daytime Phone Number:

Behavioral Health Depression Collaborative: November 17th Meeting

1. Behavioral Health Depression Collaborative: November 17th 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: