Practice in Focus Application

Practice in Focus

Practice in Focus participants have the opportunity to talk about their practice during the NCODA International Monthly Webinar. This is an ideal way to highlight the work being done within our members' facilities while connecting cancer care specialists. This application is easy to fill out and should take approximately 7 minutes. You will then be contacted by an NCODA team member who will reach out to discuss the next steps.

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* 1. Practice Name

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* 2. Mission Statement

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* 3. Location(s)

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* 4. Practice Details (how many providers, how many employees, etc)

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* 5. Accreditation(s) / Certification(s)

NCODA Center of Excellence (CoE)

URAC

ACHC

QOPI

Joint Commission

NABP

Other (please specify)

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* 6. Introduction to Your Services and Staff with a Brief Bio:

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* 7. Staff or practice photo(s)

This will be required, but can be submitted at a later date.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 8. Practice Type

Community with retail medically integrated pharmacy

Community with medically integrated dispensary

Hospital

Academia

Integrated delivery network

Other (please specify)

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* 9. Services Provided

Intravenous Therapy (IV)

Oral Oncolytics

Radiation

CyberKnife

Bone Marrow Transplant

Genetic Counseling

Financial Counseling

Imaging

CAR-T

Radiopharmaceuticals

Other (please specify)

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* 10. Why Did You Join NCODA?

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* 11. How Did You Learn or Hear About NCODA?

Facebook

Colleague

Conference

Other (please specify)

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* 12. What Areas Do You Feel Your Practice Excels At?

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* 13. What Makes Your Practice Patient-Centered?

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* 14. Is There a Novel Aspect of What You Do At Your Practice That You Think Others Could Learn From?

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* 15. What Are Some Challenges You Face Now or Anticipate Facing in the Future?

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* 16. How Would You Like to be More Involved With NCODA?

My practice would like to participate in a PQI in Action

Speaking for NCODA (International Meetings, Webinars, etc)

Authoring for NCODA (eg., Oncolytics Today, PQI, etc)

Mentoring

Committee Involvement

Other (please specify)

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* 17. How Can NCODA Help You?

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* 18. Please provide you email address for NCODA to reach out with next steps

Name

Country

Email Address