Modifiable Slide Deck: Coverage Toolkit Form

Please fill out the following information to access an editable version of the UHA Modifiable Slide Deck.

Name(Required)

First Last

Email(Required)

Organization(Required)

What role do you plan to play in an umbrella hub arrangement (check all that apply)?(Required)

Umbrella hub organization

Subsidiary

Convener

Payer

Provider

Referral hub/organization

Undecided

What geographic area will your umbrella hub arrangement serve (e.g., city, state, region, etc.)?

Will your umbrella hub arrangement work to serve underserved priority populations or those at greatest risk for developing type 2 diabetes? If so, please share more about this.

Would you like technical assistance from NACDD related to using the Modifiable Slide Deck?

Yes

This field is for validation purposes and should be left unchanged.

Content Updated: May 11, 2022

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Modifiable Slide Deck: Coverage Toolkit Form