AKI Workgroup

Please complete the form below to express your interest in being a member of the AKI Workgroup and/or to share your program's current AKI protocol. Members of the Workgroup will collaboratively work to develop a robust protocol while utilizing VCSQI data to measure progress.

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* 1. Contact Information

Name *

Organization

Speciality

Email Address *

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* 2. Check all that apply

I would like to participate in the workgroup.

I would like to share an AKI protocol for the group to review.

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* 3. Does your organization currently have an AKI protocols in place?

Yes

No, but interested in developing

Currently developing

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* 4. Please provide the email addresses of additional individuals you would like to invite to participate in this workgroup.

Invitee 1

Invitee 2

Invitee 3

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* 5. Please attached a copy of your AKI protocol.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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