used to alleviate pain in Queensland. A multi-faceted, multi-sector response is necessary to ensure optimal and safe use of prescription opioids in Queensland. Be part of this strategic, high-level conversation to improve the management of prescription opioids to reduce harm and improve outcomes for Queenslanders. Expression of interest If you are interested, complete an Expression of Interest by Wednesday 27 June and return it to Health Consumers Queensland via . If you need help to complete the form, please call Health Consumers Queensland on 07 3012 9090. Expression of Interest for QLD Clinical Senate: Managing the pain of opioids Personal Details Surname: Given Name: Address: Postcode: Phone No.: Email: Mob: Please highlight any group that you identify as being a part of: Living with a disability/chronic condition Culturally or linguistically diverse Caring for someone with a disability From a non-English speaking background Physically isolated or transport disadvantaged Please highlight to indicate your response By completing this application I consent for my details to be added to the I do not Agree Health Consumers Queensland network database agree Are you happy for Health Consumers Queensland to share this form with Yes No Queensland Clinical Senate as part of the process for this application? Would you like Health Consumers Queensland to retain this application for future vacancies? Applications not retained are destroyed once the Yes No application process is complete. Do you have lived experience with opioids? Yes No Have you been affected by opioids use in their family/community? Yes No Between Are you: Younger than 25 years 26 and 59 60 + years years
used to alleviate pain in Queensland. A multi-faceted, multi-sector response is necessary to ensure optimal and safe use of prescription opioids in Queensland. Be part of this strategic, high-level conversation to improve the management of prescription opioids to reduce harm and improve outcomes for Queenslanders. Expression of interest If you are interested, complete an Expression of Interest by Wednesday 27 June and return it to Health Consumers Queensland via . If you need help to complete the form, please call Health Consumers Queensland on 07 3012 9090. Expression of Interest for QLD Clinical Senate: Managing the pain of opioids Personal Details Surname: Given Name: Address: Postcode: Phone No.: Mob: Email: Please highlight any group that you identify as being a part of: Living with a disability/chronic condition Caring for someone with a disability Physically isolated or transport disadvantaged Culturally or linguistically diverse From a non-English speaking background Please highlight to indicate your response By completing this application I consent for my details to be added to the Health Consumers Queensland network database Agree I do not agree Are you happy for Health Consumers Queensland to share this form with Queensland Clinical Senate as part of the process for this application? Yes No Would you like Health Consumers Queensland to retain this application for future vacancies? Applications not retained are destroyed once the application process is complete. Yes No Do you have lived experience with opioids? Yes No Have you been affected by opioids use in their family/community? Yes No Are you: Younger than 25 years Between 26 and 59 years 60 + years
EOI-form-QCS-opioid-forum.docx