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Tell us what you think!
Tell us what you think!


DSCPH - 10
Geriatric Education Centers
Project Outcomes
Clinical Trainee Count Form

Please complete the Clinical Trainee Count Form which is required for government reporting. This form captures the number of trainees for EPaD GEC clinical educational experiences offered throughout our region.* (TJU, MWU, TCMC, UD, CCHS).

Name:
Phone:
Email:
Institution:
Please specify your institution:
Data Collection Period:


  Trainee Categories  
Location of Clinical Training/Patient Encounters Students Residents Fellows Health Professionals Faculty Interdisciplinary Teams Patient Encounters
CEU Non-CEU Trained Retrained
Ambulatory Care Centers
Assisted Living
Chronic & Acute Disease Hospitals
Home Care
Hospice
Nursing Homes
Palliative Care
Senior Centers
Telehealth
Other
Total


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