First Name
*
Last Name
*
Email
*
Functional Role
*
ADNS/ADON
Clinical Consultant
Corporate Clinical Director
Dietitian
DNS/DON
Executive Director/Administrator
Health Information Specialist
Infection Preventionist
LTC Service Provider/Vendor
Nurse Assessment Coordinator/MDS Coordinator
Nurse Consultant
Occupational Therapist
Other
Other MDS/RAI Professional
Other Nurse Executive
Physical Therapist
Quality Improvement Professional
Rehabilitation Nurse
Reimbursement Specialist/Corporate Consultant
Social Worker
Speech Therapist
Staff Development Educator
Staff Nurse
State
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
GU
PR
VI