Alaska Medical Provider ECHO
Submit General Questions:
Question:
Submit Case Presentation:
Presenter Name:
Presenter Role:
Community:
Date:
/
Month
/
Day
Year
Date
Does your question relate to a
Patient
Procedure in your practice
Mandates and Protocols
Testing
Treatment
Other
Section 1
Brief summary of presenting case:
Significant past medical history or co morbidities:
Current medications (if relevant):
What help would you like from the panel?
Section 2
Brief summary of presenting problem:
What help would you like from the panel?
Question:
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