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HHCAHPS Training Registration Form

Home Health Care CAHPS - Training Registration Form

Name of Organization
Address:
Mailing Address 1
Mailing Address 2
City
State
Zip Code
Telephone No	(include area code)

Your Name
Your e-mail address	(Note that this is the address to which information on how to access the training will be sent prior to the training session):

Is your organization a (select one):

Survey Vendor -> Answer question below and then go to PART II
Home Health Agency -> Go to PART II
Other Specify other type of organization below and then skip to PART II

*** Survey vendors seeking to become an approved Home Health Care CAHPS Survey vendor must designate a staff member as the Home Health Care CAHPS Survey Project Manager. The Staff member designated as the HHCAHPS Project Manager must complete a training certification following the training. Survey vendors who have already been approved do not need to complete the training certification. ***

Are you the designated CAHPS Project Manager for your organization?

Yes
No

PART II

Indicate which session you are registering for. Vendors applying to become HHCAHPS Survey Vendors must attend both Session I and Session II. Note that all times are Eastern Time.

Intro Session 1, Tuesday, January 29, 2019, 1:00 PM - 5:00 PM ET
Intro Session 2, Wednesday, January 30, 2019, 1:00 PM - 5:00 PM ET
Update Session, Friday, February 1, 2019, 12:00 PM - 2:00 PM ET