Transplant Improvement Program for Success (TIPS)

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* 2. Complete the below information.

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* 3. Please list the Primary and Secondary Contacts for this project. (If UNKNOWN, list the Facility Administrator for the Project Lead and Regional Corporate Representative as the Backup)

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* 4. Do you know what a Transplant Learning and Action Network (LAN) is?

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* 5. Do you have a Facility Patient Representative (FPR), Patient Subject Matter Expert (SME) or an ACTIVELY engaged patient who's part of the facility's activities?

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* 6. Does your facility serve patients from a vulnerable population? If so, please select all that apply.

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* 7. Does your facility serve patients with health disparities? If so, please select all that apply.

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* 8. Does your facility hold monthly patient engagement or educational activities related to Transplant for all patients?

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* 9. Do any of your patients and/or family members participate in the QAPI/QA program/meetings?

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* 10. Have you notified your regional corporate representative that your facility has been selected to participate in the 2018 Transplant Waitlist QIA?

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* 11. Do you feel that you have or will have the facility resources, staff and corporate support necessary for your facility to successfully participate in the 2019 Transplant Waitlist QIA? If you select "No" please explain why in the next question. .

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* 12. If you answered "No" to Q11, please explain what do you need in order to fully participate and be successful in the 2019 Transplant Waitlist QIA?

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* 13. Who is the primary person in charge of educating and making referrals for transplant in your facility?

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* 14. What do you hope/would like to gain by participating in this Quality Improvement Activity?

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