Thank you  for attending today's Indian Country MCH teleECHO clinic. The 1 hour long session includes an opportunity to present cases, receive recommendations from an interprofessional team of specialists and an opportunity to engage in a didactic session.

Please complete the sign-in information below for today's clinic attendance. 

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* 1. Please choose the date of the MCH ECHO Clinic you are attending:

Date

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* 2. Please Enter Your Contact Information. (If you would like a copy of the clinic's slides, please include a valid email address.)

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* 3. What is your professional licensure?

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* 4. Is your organization affiliated with an IHS (Indian Health Service), Tribal, or Urban (I/T/U) organization. Select one:

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* 5. Please select which IHS Service Area your tribe/ tribal organization/ clinic is located in?

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* 6. What question(s) do you have relating to Maternal and Child Health? Our faculty will respond directly if an email is listed above.

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* 7. What additional didactic presentations and topics would you like to see included in future Maternal and Child Health ECHOs?

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