DC DEPARTMENT OF HEALTH | Health Regulation and Licensing Administration
BRIDGING THE QUALITY CHASM 2.0

Friday, October 19, 2018
Kellogg Conference Center
Gallaudet University
Washington DC 20002

Register to attend "Bridging the Quality Chasm 2.0," which will be held on October 19, 2018, at the Kellogg Conference Center at Gallaudet University, 800 Florida Avenue, NE, Washington, DC 20002. Registration table to open at 8:30 am; program will be held at 9:00 am - 12:00 noon.

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* 1. Your Name

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* 2. Your Job Title

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* 3. Your Discipline (licensure)

RN/LPN

Nursing Home Administrator

Other (please specify)

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* 4. Phone Number

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* 5. Email Address

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* 6. Facility Name

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* 7. Facility Type

Ambulatory Surgical Center

Hospital

Nursing Home

Other (please specify)

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* 8. Is your Facility registered with ECRI to submit Adverse Events?

Yes

Not Sure

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* 1. Your Name

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* 2. Your Job Title

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* 3. Your Discipline (licensure)

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* 4. Phone Number

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* 5. Email Address

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* 6. Facility Name

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* 7. Facility Type

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* 8. Is your Facility registered with ECRI to submit Adverse Events?

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* 9. Other topics you are interested in