HLU2M NVQTAC PII Security 2014 Training

Privacy & Security Training Test for Self-Management Programs

The Nevada Quality and Technical Assistance Center (NV QTAC) recommends that all LAY Leaders in Nevada participate in the Privacy & Security Training regarding the Stanford University Chronic Disease and Diabetes Self-Management programs (English and Spanish) for data collection forms and procedures.

After participating in the live or archived webinar for this Privacy & Security Training, we ask each Leader to complete this short test. All questions must be answered in order for this to be reviewed and counted as 'complete' for purposes of our compliance records.

Question Title

* 1. Provide your full name and Contact Information:

First Name

Last Name

Email address

Phone #

Mailing address

City

State

Zipcode

Question Title

* 2. Indicate the organization name that you will be serving as a Lay Leader for Stanford University programs (e.g. CDSME and DSME).

Question Title

* 3. Are you currently a Lay Leader the NV QTAC Stanford License?

Yes

Unsure

Other (please specify)

Question Title

* 4. What is your role with your organization for purposes of the Stanford University programs?

	Yes	No	Unsure
Self-Management Program Coordinator	Self-Management Program Coordinator Yes	Self-Management Program Coordinator No	Self-Management Program Coordinator Unsure
Master Trainer	Master Trainer Yes	Master Trainer No	Master Trainer Unsure
Lay Leader	Lay Leader Yes	Lay Leader No	Lay Leader Unsure
Other	Other Yes	Other No	Other Unsure

Other (please specify)

Question Title

* 5. Have you submitted your signed Non-Disclosure Agreement to NV QTAC?

Yes

Unsure