Best Practices Submission Form Thank you for submitting your practice to AMCHP’s Innovation Station database of cutting edge, emerging, promising and best practices in MCH. Your submission will be carefully reviewed by AMCHP’s Best Practice Review Panel. If accepted, you may be asked to submit additional program information to compile a summary that will be included and promoted through Innovation Station. Contact Information Name: Organization: Address: City, ZIP: Phone: E-mail Address Program / Initiative Overview Name of Program Program Name] Initiative Adolescent Health Perinatal/Infant Health Children and with Special Health Women’s/Maternal Health Care Needs Cross-cutting/ Life course Primary population Check all that apply Access to Health Care Health Inequity/Disparity Primary/Preventative Health Autism/ Dev. Disabilities Health Promotion Care Birth Defects Prevention Health Screening Quality Assurance Outcomes (incl. Intentional/Unintentional Reproductive Health infant mortality, Injury Service prematurity) Maternal Coordination/Integration Chronic Disease mortality/morbidity Specialized Care Data Mental Health Substance/Tobacco Use Primary issue Assessment/Evaluation Nutrition/Physical Activity Workforce Development & focus of your Emergency Preparedness Oral Health Leadership program/initiative Family/Consumer Prenatal Care Other: Check all that Involvement apply Financing& Insurance
Best Practices Submission Form Thank you for submitting your practice to AMCHP’s Innovation Station database of cutting edge, emerging, promising and best practices in MCH. Your submission will be carefully reviewed by AMCHP’s Best Practice Review Panel. If accepted, you may be asked to submit additional program information to compile a summary that will be included and promoted through Innovation Station. Contact Information Name: Organization: Address: City, ZIP: Phone: E-mail Address Program / Initiative Overview Name of Program Initiative Program Name] Primary population Check all that apply Adolescent Health Children and with Special Health Care Needs Cross-cutting/ Life course Perinatal/Infant Health Women’s/Maternal Health Primary issue focus of your program/initiative Check all that apply Access to Health Care Autism/ Dev. Disabilities Birth Defects Prevention Outcomes (incl. infant mortality, prematurity) Chronic Disease Data Assessment/Evaluation Emergency Preparedness Family/Consumer Involvement Financing& Insurance Health Inequity/Disparity Health Promotion Health Screening Intentional/Unintentional Injury Maternal mortality/morbidity Mental Health Nutrition/Physical Activity Oral Health Prenatal Care Primary/Preventative Health Care Quality Assurance Reproductive Health Service Coordination/Integration Specialized Care Substance/Tobacco Use Workforce Development & Leadership Other:
Best%20Practices%20Submission%20Form_2017.docx