Health Equity National Pilot

Hospital Name

Address

City

State

ZIP/Postal Code

Contact Name

First Name

Last Name

Contact Title

Contact Email Address

Select All That Apply

My organization is interested in completing the progress report

My organization would like to be considered for placement in the eight-week learning collaborative*

What brought you to engage with the Racial Equity in Healthcare Progress Report national pilot?

Sourced through my state hospital association

Institute for Healthcare Improvement (IHI)

LinkedIn/RUSH Website

The Joint Commission

Telligen

Other

Please specify: