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* 1. First and Last Name

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* 2. Please list your credentials as you would like them to appear on your CME certificate

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* 3. How familiar were you with the No Surprises Act prior to this activity?

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* 4. Have you already implemented provisions of the No Surprise Act?

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* 5. What new strategies will you implement as a result of your participation

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* 6. Describe any barriers you perceive to implementation of the No Surprises Act requirements?

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