HR1 Medicaid training reporting form

HR1 Medicaid training reporting form

Thank you for helping educate New Jersey communities about the upcoming Medicaid changes under HR1. Please complete this form each time your organization conducts an HR1-related training. This information helps the Camden Coalition and Regional Health Hubs understand community outreach efforts, identify unmet needs, and coordinate future education.
- Organization name
- Primary contact
  
  First NameLast Name
- Job title
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- What county or counties do you serve? (Check all that apply)
  
  Other
- If other, please list additional counties
- Training date
  
  MonthDayYear
  Date
- Training location
- Training format
- Which Camden Coalition training did you use?
- Audience: Who attended the training? (Check all that apply)
  
  Other
- If other, please specify
- Number of attendees (Please specify adults/children)
  Adults / Children
- Number of organizations represented
- Topics covered during the training (Check all that apply)
  
  Other
- If other, please explain
- What question(s) came up most frequently?
- Were there any immigration statuses or situations that caused confusion?
- What additional training(s) would help your organization?
- Did participants request additional materials?
- If yes, please specify
- Upload photos, agendas, sign-in sheets or other materials.
  
  Cancelof
- Would your organization like follow-up support? (Check all that apply)
- Additional comments
Should be Empty: