Biographical Information

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* 1. Name

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* 2. Degrees

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* 3. Designations

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* 4. Title

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* 5. Company/Organization Name

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* 6. Address

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* 7. Phone Number

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* 9. Current Position by General Role

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* 10. Hospital Owership

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* 11. Hospital Type

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* 12. Hospital Size

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* 13. Please select your gender identity

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* 14. Age

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* 15. Race and Ethnicity (*Options determined based on proposed U.S. Census categories). May select multiple categories

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 20% of survey complete.

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