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1. RHC Profile

IMPORTANT: In order to prevent duplication, please provide only one response per organization

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* 1. Please enter your number of RHC(s) by type:

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* 2. Please list the state(s) that your organization operates RHCs in:

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* 3. Across all RHCs in your organization, please indicate the total Full-Time Equivalents (FTEs) of the following RHC practitioners from CY 2025 across all RHCs you represent. This question is intended to gain insight into the size of your organization. Please note that a number in every field is required, and than 0 is an acceptable figure.

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* 4. Do your RHCs offer a sliding fee scale?

Note: In order to improve the validity of this survey we may want to verify certain data points. While providing the following is optional, if you are able to provide the following information, it will help improve the strength of this survey. Please also note that all completed surveys that include contact information will be entered in a drawing for a Visa gift card.

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* 5. (Optional) What is the name of your organization?

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* 6. (Optional) Contact information:

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