Submit Your Story

Online Form Instructions:
Please complete the following form. All submissions will be reviewed and posted, if all criteria are met, within 10 business days. Criteria include, but may not be limited to, the following:

Baseline data are available
An intervention was fully implemented
Data were collected to test the intervention
QI effort ultimately resulted in a measurable improvement
Formal QI framework was used (e.g. PDCA, Lean, etc.)

Bold items are mandatory.

1. Health Department Name:

2. State:

3. Email:

4. Phone Number:

5. Health Department Website:

6. Name:

7. Title of Contact Person:

8. OK to post contact information?:

Yes

9. Governance Structure:

If other, please specify:

10. Approximate Population Served:

11. Primary Population Served:

Urban

Rural

Suburban

Frontier

(check all that apply)

12. Approximate Annual Budget:

13. Number of Full Time Employees:

14. Has the health dept. been awarded accreditation by an accrediting body?:

Yes

(e.g., PHAB, JCAHO, state-based accreditation, etc.)

If yes, please specify: