Election Information

Below is your election ballot for Qsource ESRD Network 12 Board of Directors and Medical Review Board. Since you may not be familiar with the candidates on a personal/professional level, a short biography on each of the candidates is available on each page of the survey to assist you in the decision-making process. Incumbents are not required to submit a statement, however, if they are on the ballot, they have met all Network criteria to continue their service on the Boards.

Newly elected Board members will be notified by the end of Decemer and they will serve for the 2020-2022 term. The final results of the election will be announced to the Boards and the Network at-large during the 2020 Annual Network Council Meeting.

At this time, please review the nominated candidates, mark your vote below and submit no later than 5:00 pm on Wednesday, December 18, 2019. If you have any questions, please contact dulm@qsource.org.

REMINDER: EACH FACILITY CAN ONLY VOTE ONE TIME. IF YOU ARE A FACILITY REP FOR MORE THAN ONE UNIT, PLEASE LIST ALL MEDICARE PROVIDER NUMBERS (CCN) THAT YOU ARE REPRESENTING. 

*Denotes Incumbent

Question Title

* 1. Medicare Provider Number(s) (CCN #). Please list ALL CCN numbers that you are representing

Question Title

* 2. Name

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