País * Afganistan Albania Alemania Andorra Angola Anguilla Antartica Antigua And Barbuda Arabia Saudita Argelia Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Bélgica Belice Benin Bermudas/Antillas Britanicas Bhutan Bolivia Bosnia Y Herzegowina Botswana Brasil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Camboya Camerún Canadá Chad Chile China Chipre Colombia Comoros Corea Costa Rica Cote D´Ivoire Croacia Cuba Dinamarca Djibouti Dominica East Timor Ecuador Egipto El Salvador Emiratos Arabes Unidos Eritrea Eslovaquia Eslovenia España Estados Federados De Micronesia Estados Unidos Estonia Etiopía Fiji Filipinas Finlandia Francia Gabón Gambia Georgia Ghana Gibraltar Grecia Grenada Groenlandia Guadalupe Guam Guatemala Guinea Guinea Ecuatorial Guinea Francesa Guinea-Bissau Haití Holanda Honduras Hong Kong Hungría India Indonesia Irak Irán Irlanda Isla Bouvet Isla Cocos (Keeling) Isla Cook Isla Mauricio Isla Navidad Isla Norfolk Islandia Islas Caimán Islas Falkland (Malvinas) Islas Faroe Islas Georgia Del Sur Y Sandwich Islas Heard And Mc Donald Islas Marshall Islas Northern Mariana Islas Salomón Islas Svalbard And Jan Mayen Islas Turks And Caicos Islas United States Minor Outlyi Islas Vírgenes (Británicas) Islas Vírgenes (U.S.A.) Islas Wallis And Futuna Israel Italia Jamaica Japón Jordania Kazakhstan Kenia Kiribati Kuwait Kyrgyzstan Lesoto Letonia Líbano Liberia Libia Arab Jamahiriya Liechtenstein Lituania Luxemburgo Macao Macedonia Madagascar Malasia Malawi Maldives Mali Malta Marruecos Martinica Mauritania Mayotte México Mónaco Mongolia Monserrat Mozambique Myanmar Namibia Nauru Nepal Nicaragua Niger Nigeria Niue Noruega Nueva Caledonia Nueva Zelanda Omán Pakistán Palau Panamá Papua New Guinea Paraguay Perú Pitcairn Polinesia Francesa Polonia Portugal Puerto Rico Qatar Reino Unido Republica Checa Republica De Africa Central Republica De Congo Republica De Corea Republica De Moldova Republica Democratica De Laos Republica Democratica Del Congo Republica Dominicana Reunión Ruanda Rumanía Rusia Sahara Occidental Saint Kitts And Nevis Samoa Samoa Americana San Marino San Tomás y Príncipe San Vincent And The Grenadines Santa Lucía Senegal Serbia Seychelles Sierra Leona Singapur Siria Somalia Sri Lanka Sudáfrica Sudán Suecia Suiza Surinam Swaziland Tailandia Taiwán República de China Tajikistán Tanzania Territorio De Indias Británicas Togo Tokelau Tonga Trinidad y Tobago Túnez Turkmenistán Turquía Tuvalu Ucrania Uganda Uruguay Uzbekistán Vanuatu Vaticano Venezuela Vietnam Yemen Zambia Zimbawe

Provincia * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Nombre *

Apellidos *

Email de la organización *

Teléfono *

Cargo *

Rol * Case Manager Clinician/Physician/Practitioner Education (Preceptor or Educator) Executive/Executive Director Faculty Fellow Frontline Supervisor Informaticist IT Librarian Marketing Nurse Management (Charge Nurse, Lead Nurse, etc) Nurse/RN Other Patient Care/Quality/Compliance/Safety Pharmacist Pricing and Reimbursement Resident/Trainee Sales Staff Development/HR Student Support Worker

Rol * Executive/C. Level Department Lead/Management Librarian Head of school/Dean/Vice Dean Course Lead/Head of Year Professional/Practitioner Researcher Lecturer/Instructor Student Trainee/Junior doctor

Organización *

Tipo de organización * Academic (Medical, Pharmacy or Nursing College/University) Government (DoD, Federal, State, etc.) Non-Profit (Association, Foundation, etc) Payer (Health Plans, Benefits Management, Care Organization, PBM, TPA, etc.) Pharmaceutical - Manufacturer/Distributor Pharmaceutical - Retail Pharmacy Private Practice  Professional Services - Coding/Medical Transcription Service Professional Services - Consulting Professional Services - Legal Provider - Ambulatory/Out-Patient Facility Provider - Healthcare Network Provider - Home Health Care/Agency Provider - Hospital Provider - Human Services Provider - Long Term Care (Nursing Home, Skilled Nursing Facility, Rehabilitation Center, etc.) Provider - Medical Group Practice Technology (HIT, EMR, EHR, etc.)

Tipo de organización * Academic Corporate Distributor Funding Body Government Health Medical/Health Reseller Societies/Associations Other

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