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Project Information
Participant(s)
Health Care Consulting (HCC) Project Request Form
Project Request Details
Member
*
Altru Health System
Arizona State University
Augusta Health
Baptist Health Care - Pensacola
Baton Rouge General
Beacon Health System
Billings Clinic
Blanchard Valley Health
Blount Memorial Hospital
Carteret Health Care
CHRISTUS St. Vincent
Foundation Health Partners
Guthrie
Hancock Health
Hendricks Regional Health
Johnson Memorial Health
Lake Regional Health System
Mama Lucy Kibaki Hospital (StanMed)
Marion Health
Memorial Health System
Middlesex Health
Minnesota Oncology
Monument Health
Mosaic Life Care
Nakuru County Referral and Teaching Hospital (StanMed)
NorthBay Health
Ray County Hospital and Healthcare
ReDaT HealthCare (StanMed)
Shannon
St. Clair Health
StanMed
Stormont Vail Health
The Baton Rouge Clinic
ThedaCare
TMC HealthCare
Trinity Health
Unity Health - Searcy, AR
VHC Health
Wellstar Health System
Western Kenya Heart and Cancer Hospital (StanMed)
Willis-Knighton Health System
Witham Health Services
Yuma Regional Medical Center
Submission Role
*
Submission Role
Project Owner
Submission Role
HCC Liaison
Submission Role
Operations Manager (Mayo Clinic use only)
Project Title
*
*
Project Goals/Objectives
*
*
Primary Priority
*
*
Secondary Priority
*
*
Measurable Outcomes
Measurable Outcomes
*
*
Questions
Question 1
*
*
Question 2
*
Question 3
*
Question 4
*
Question 5
*
Question 6
*
Project Owner and Assistant
First Name
*
*
Assistant First Name
*
Last Name
*
*
Assistant Last Name
*
Work Email
*
*
*
Assistant Work Email
*
*
Title
*
*
Assistant Title
*
Phone
*
Assistant Phone
*
Is Project Owner also a Participant?
*
Is Project Owner also a Participant?
No
Is Project Owner also a Participant?
Yes
Will there be additional participants?
*
Will there be additional participants?
No
Will there be additional participants?
Yes
