AHRQ Safety Program for Long-Term Care: CAUTI ORGANIZATIONAL CONTACT INFORMATION Name of Lead Organization: Name, Phone Number, and Email of Org Lead: PROJECT INFORMATION Learning Learning Meeting Type (Check One): Estimated # of Facilities: Session #1 Session #3 Learning Other Session #2 (Explain) Will facilities that did not participate in CAUTI LTC attend? Y/N: Check if any other safety project participants will be attending: Please describe: MEETING LOGISTICS Preferred meeting dates: Meeting dates to 1) 1) (i.e. statewide meetings that can avoid: 2) 2) include a CUSP meeting) 3) 3) Meeting Start & End Time: Meeting City: Name of Meeting Venue: List Lodging Option(s): 1) 2) Please list the name & title of any state consortium members who may be attending the meeting (i.e. State QIO, Department of Health, PSO, elected officials, etc.): 1) 2) MEETING CONTENT Please list topics of concern that you would like covered at this meeting: 1) 2)
AHRQ Safety Program for Long-Term Care: CAUTI ORGANIZATIONAL CONTACT INFORMATION Name of Lead Organization: Name, Phone Number, and Email of Org Lead: PROJECT INFORMATION Meeting Type (Check One): Learning Session #1 Learning Session #3 Estimated # of Facilities: Learning Session #2 Other (Explain) Will facilities that did not participate in CAUTI LTC attend? Y/N: Check if any other safety project participants will be attending: Please describe: MEETING LOGISTICS Preferred meeting dates: (i.e. statewide meetings that can include a CUSP meeting) 1) Meeting dates to avoid: 1) 2) 2) 3) 3) Meeting Start & End Time: Meeting City: Name of Meeting Venue: List Lodging Option(s): 1) 2) Please list the name & title of any state consortium members who may be attending the meeting (i.e. State QIO, Department of Health, PSO, elected officials, etc.): 1) 2) MEETING CONTENT Please list topics of concern that you would like covered at this meeting: 1) 2)
Enrollment%20Packet_Cohort3_FINAL.docx