APPLICATION FOR CANCER SCREENING IMPROVEMENT INITIATIVE

This funding will support clinics to focus on improving cancer screenings. For year one of the funding, each clinic chosen to participate in the project will receive a total of $10,000 for the year, which will be broken into payments once metrics are met.
SECTION I: CLINIC DETAILS & ORGANIZATIONAL PROFILE
1.Applicant Organization:
2.Primary Clinic Location:
3.Facility Type:
4.Contact Person:
5.Email Address:
6.Phone Number:
7.Number of Physicians:
8.Number of PA's:
9.Number of APRNs:
10.What EHR are you on: