NJAFP DSME/DPP How-To Guide How-To Guide Enrollment Form Question Title * 1. Practice Information Practice Name Street City State Zip Name of ACO (if applicable) Name of EHR system (if applicable) Question Title * 2. Type of practice Solo practice Group practice FQHC Other (please specify) Question Title * 3. Program Contact Name Title Email Phone Question Title * 4. How did you hear about this program? Email E-newsletter NJAFP Journal "Perspectives" Colleague Other (please specify) Question Title * 5. How would you like to engage in this program? CARBS How-to Guide only CARBS How-to Guide and Coaching Support Unsure/Other (please specify) Done
