We are so pleased you have decided to participate in Track 2 of the Introductory Mental/Behavioral Health Learning Collaborative - the optional MOC part 4 QI project. Please register by answering a few brief questions below.

If other physicians in your practice team are participating, each physician needs to fill out their own registration form. We also ask that you involve other staff on your QI project practice team and fill in their information below.

Thank you!

Again, this registration survey is required for all those seeking to participate in our MOC Part 4 Quality Improvement Track (Track 2) only. Those not interested in the QI project can attend any/all of the virtual Learning Collaborative sessions as their schedule permits, without needing to complete a program registration form; only registering for the individual zoom sessions, as needed.


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* 1. Please confirm you're signing up for the MOC Part 4 Quality Improvement Project (Track 2):
 
Participants need to attend all 6 Learning Collaborative sessions (November 18th, December 16th, January 20th, February 17th, March 17th and April 21st.) Details on program requirements will be shared during orientation on October 21, 2022 12:15-1:15pm (register HERE). Participants will be awarded 25 MOC part 4 points upon completion.

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* 2. First and Last Name:

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* 3. Email Address:

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* 4. Best phone number to reach you:

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* 5. Designation (MD, DO, APN, PA, etc.):

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* 6. Practice Name:

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* 7. Practice County:

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* 8. AAP ID Number

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* 9. To participate in the MOC Part 4 Quality Improvement Track of the Introductory-Level Learning Collaborative, you must be a member of the NJPPC.
If you would like to learn and become a member of the NJPPC please click HERE.

Please select an answer that applies to you.

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* 10. Quality Improvement projects are most successful when they involve a team. Please list the names, designation and email addresses of all practice quality improvement project team members(other physicians, nursing staff, office manager etc.):

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* 11. Below are the topics for each session:

November 18th: Early Identification of Pediatric Mental/Behavioral Health Issues & How to Address in Primary Care 
December 16th: Screening for Pediatric Mental/Behavioral Health Issues: A Practice Team Approach 
January 20th: Referral & Care Coordination: Working in Collaboration with Your NJPPC Hub
February 17th: Collaborating with NJPPC CAPs on Treatment & Co-Med. Management 
March 17th: Community Resources and Communicating with Families about Mental/Behavioral Health Concerns
April 21st: Sustainability & Storyboards 

What are you interested in learning that you want us to be sure to include in these sessions? 

Thank you for completing the Registration form for Track 2 of the Introductory Mental/Behavioral Health Learning Collaborative.
Please also register for the orientation webinar by clicking HERE

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