CDP Registration Form - Addressing Suicide with Military-Connected Patients

Participant Information

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* Contact Information:

Name

State

Country

Email Address

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* Are you currently a Tricare provider?

Yes

No

Other (please specify)

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* What is your National Provider Identifier number?

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* Are you seeking CEs?

Yes

No

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* Are you pursuing the TRICARE Readiness Designation?

Yes

No

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* I understand that once I have completed all six modules, my name and NPI number will be shared with the Defense Health Agency(DHA) and the TRICARE program.

I affirm.