QI Project Enrollment Form

Complete the information below to request enrollment in a currently approved project. Completion of this form does not verify acceptance. You will be contacted by the project leader or the MOC Portfolio Administrator with additional information. Incomplete or insufficient information may delay approval for participation in the project. Please allow up to 1 week to receive a response regarding your form submission. 
Currently Approved Individual Projects

 Project   Enrollment Cut-Off Date  
 Bronchiolitis (for the outpatient setting)    Open
 Pneumonia (for the outpatient setting)    Open
Assessing and Improving Physician Wellness         Open

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* 1. Which project would you like to join?

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* 2. Please provide the following demographic information. 

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* 3. MOC project participation at ETCH requires completion of the Institute for Healthcare Improvement (IHI) Open School Online Course: QI 102: How to Improve with the Model for Improvement.

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* 4. Upload your IHI QI 102 certificate of completion.

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Contact the MOC Portfolio Administrative team with any questions: CME@etch.com

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