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Please type responses here: |
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First name:
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Last name:
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Email Address:
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Retype Email Address:
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Phone number:
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Institution:
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Title:
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Address:
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City:
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State:
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Country:
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Zip/Postal Code:
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At what type of laboratory are you currently employed?
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Hospital
Reference
Academic
Physician Office
Other
I do not work in a laboratory
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If you chose 'Other' above, please describe the type of laboratory at which are you currently employed:
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My credentials (i.e., MD, RN, PHD, etc.): Please fill in the blank:
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I practice/work in: (select all that apply)
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Emergency
Hospital
Urgent Care
Primary Care
Pharmacy
Specialized clinic
Long-term Care/Nursing home
Other clinical setting
Medical Distributor/Manufacturer/Supplier (If selected, please skip to the following question)
Non-clinical setting
Other
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I specialize in: (select all that apply)
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Pediatrics
Family Medicine/Internal Medicine
Emergency Medicine
Urgent Care
Student/Resident
Administration
Pharmacy
Other area of clinical care
Operations/Practice Management
Other
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Are you confident in your organization’s plan and procedures for navigating a crisis?
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Yes
No
I don’t know
N/A
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Do you believe that situational awareness and emotional intelligence impact your ability to safely and efficiently complete your day-to-day work?
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Yes
No
I don’t know
N/A
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By registering for this webinar, Whitehat uses your information to communicate with you regarding this webinar and other educational events.
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Yes, I consent to give my information to receive communication regarding this webinar
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By registering for this webinar, the information you provide will be shared with the webinar’s sponsors to provide you with information on products and services that may be of interest to you:
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Yes, I consent to receiving marketing communication from this webinar’s sponsors following the webinar
No, thank you
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After clicking 'submit', you
will be redirected to the webinar recording.
You will also
receive an email with the link to the evaluation to fill out
after you finish the recording. |
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