MHI - Let's Talk: May 14th, 2018 "Opioid Crisis" with Dr. Rachel Levine from 12:00 PM - 1:30 PM

Registration: PA MHI Let's Talk: Opioid Crisis- 5/14/18 12:00 PM - 1:30 PM

Webinar, phone link, CME/CEU information, and handouts will be emailed to registrants prior to the event.
Questions starred below (*) require answers.

Question Title

* 1. Name, email, phone

First Name

Last Name

Email Address (required for handouts)

Phone

Question Title

* 2. Your Professional credentials:

MD/DO

RN/BSN

LPN

Medical Assistant

MEd.

Registered Dietitian

CRNP

Other (please specify)

Question Title

* 3. Practice, hospital, or organization name:

Name of Practice/Organization/School

Mailing Address

City

State

Zip

County

Question Title

* 4. Specify pediatric, family medicine, or other practice or organization type

Pediatric

Pediatric Residents

Family medicine

Family Medicine Residents

Other medical practice

Registered Dietitian solo or group practice

School nurse

School employee/staff other than nurse

Public Health Department

Child day care

WIC

K-12 teacher, staff, or coach

Other community setting

Other (please specify)

Question Title

* 5. Expected number of participants from my site. (If only you, then "1")

Question Title

* 6. My practice/organization will join by: Please check one

Webinar (one computer connection with sound accessible by phone). Webinar space is limited. Once webinar slots are filled, participants will only be able to listen by phone and use the handouts emailed to you.

Teleconference only (via phone only). Handouts will be emailed to you.

Question Title

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference.
Your handouts and connecting instructions will be emailed to you.
We look forward to your participation!

Question Title

* 1. Name, email, phone

Question Title

* 2. Your Professional credentials:

Question Title

* 3. Practice, hospital, or organization name:

Question Title

* 4. Specify pediatric, family medicine, or other practice or organization type

Question Title

* 5. Expected number of participants from my site. (If only you, then "1")

Question Title

* 6. My practice/organization will join by: Please check one

Question Title

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference. Your handouts and connecting instructions will be emailed to you. We look forward to your participation!

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference.
Your handouts and connecting instructions will be emailed to you.
We look forward to your participation!