January 2024 HIPAA Training Registration

HIPAA Training Registration

January 5th, 2024

10:00 am - 11:00 am

Zoom online

Please register by January 3, 2024

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1. What is your first name? (Required.)

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2. What is your last name? (Required.)

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3. What is your email address? (Required.)

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4. What is your phone number? (Required.)

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5. What is your address?

Address

Apt/Suite

City

State

Zip Code

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6. What is your Organization/Agency name?

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7. Did you complete the Community Health Worker training?

Yes

No