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To learn more about GroundGame Health™, please complete the following survey.
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1.
Organization Name:
(Required.)
2.
Organization City, State:
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3.
Your name:
(Required.)
*
4.
Your Title:
(Required.)
*
5.
Your information
**
:
**You will receive a GroundGame Health™ e-newsletter. We will never sell or distribute your information to third-party sources.
(Required.)
E-mail Address
Phone Number
6.
My organization is currently accredited by (select all that apply):
NCQA
CARF
URAC
COA
TJC
N/A
Please specify other accreditation(s) here
7.
My organization has experience participating in (select all that apply):
A Care Management Program
A Care Transitions Program
An Integrated Care Model
None of the above
8.
My organization is best described as:
Area Agency on Aging (AAA)
Community Based Organization (CBO) - limited service area
Community Based Organization (CBO) - multi-county area
Other (please specify)
