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* 1. Would you be interested in participating in a public, stakeholder engagement forum regarding the Hospital Transformation Program (HTP)?

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* 2. What aspects of the HTP would you be interested in discussing? Please check all that apply.

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* 3. If you are interested in participating, please provide your contact information (name and email) and your relationship with the HTP (provider, community organization, patient advocate, etc.).

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* 4. Additional comments

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