HAP RHELAN Cohort Selection_2024

Please complete the survey below to indicate your participation in one or both of the HAP RHELAN 2024 cohorts, and to provide us with a means of contacting you. Thank you.

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* 1. Name

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* 2. Title

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* 3. Hospital or Healthysystem

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* 4. Email

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* 5. Phone

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* 6. Culturally Appropriate Patient Care Cohort

Yes, I wish to lead my hospital or healthsystem in this HAP RHELAN initiative.

No, I do not wish to lead my hospital or healthsystem in this HAP RHELAN initiative.

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* 7. Collection and Use of Data to Drive Action Cohort

Yes, I wish to lead my hospital or healthsystem in this HAP RHELAN initiative.

No, I do not wish to lead my hospital or healthsystem in this HAP RHELAN initiative.

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* 8. Will you be convening a hospital team to work on this initiative?

Yes

Unsure at this time

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* 9. If you wish teammates to receive communication about the cohort(s) directly from HAP, please indicate names and contact information below. If you want communication to only be sent directly to you (for dissemination within your organization), you may skip this step.