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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
<Select State>
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Outlying Islands
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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 HHCAHPS Project Manager for your organization?
Yes
No
PART II
Indicate which session you are registering for. Vendors applying to become HHCAHPS Survey Vendors must register for and complete the Introduction to HHCAHPS Survey self-paced training. Note that all times are Eastern Time.
Introduction to HHCAHPS Survey, Self-paced training
Update Session, Friday, January 29, 2021, 12:00 PM - 2:00 PM ET