General Information

To enroll in CO AIM: SUD and MOMs+, please complete the form below. Once submitted, a member of the CPCQC Team will reach out to you to schedule a follow up Zoom meeting to learn more about your hospital's specific needs.

Thank you for your interest in working with us to address perinatal substance use in Colorado!

If you have any questions, please reach out to info@cpcqc.org.

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* 1. Please enter your name:

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* 2. What is your email address? 

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* 3. Hospital/Organization

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* 4. What Electronic Medical Record (EMR) system do your MDs use? (e.g. Epic, Cerner, Meditech)

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* 5. If different from above, what EMR or charting system do your nurses use? 

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* 6. If your facility is owned by a larger hospital system, please enter that name here (e.g. UC Health, Centura, SCL): 

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