Directions:
PA PQC healthcare teams participating in either the Maternal Substance Use or Substance Exposed Newborn initiative are eligible to request trainings that the PA PQC will help to organize. Please use this form to request a training. The PA PQC will then be in touch with you to learn more about the training that is needed, logistics, and next steps.

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* 1. PA PQC Hospital

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* 2. Name, title, and organization of the person completing this form.

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* 3. Please select the training topic that your PA PQC healthcare team has identified as a need for providers and staff in your organization.

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* 4. Would you prefer this training to be in-person or virtual?

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* 5. Please identify an ideal, targeted timeframe for the requested training.

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* 6. Please describe any previous training or work on this topic at your organization. Also describe any specific learning objectives and needs for the training(s) you selected. 

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