Submitted by Keith Hand CA on May 17, 2019 - 01:40 PM

Age-Friendly Health Systems: Commitment Form

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Addressing the unique care needs of older adults.

 

Thank you for your commitment to joining the AHA’s Age-Friendly Health Systems Action Community from fall 2020 through April 2021. Please enroll by September 14 to attend our Getting Started webinar on either September 16 or 24, 2020. We will continue to accept submissions till September 30, 2020. Participation in the Action Community — including all webinars, coaching and resources — is free.

Please complete this form and feel free to reach out to ahaactioncommunity@aha.org with any questions. We look forward to working with you!

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State
Name

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List who would like to enroll in this Action Community.

Please enter the clinical sites, if inpatient or outpatient setting, and a key contact for each site.

Example: Test Hospital Unit 1  |   inpatient   |   Jane Smith   |   jsmith@test.org

Site(s)
Site(s)
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Note: Add additional sites using the + option.

Please identify your senior leader or sponsor. The senior leader/sponsor will support scale-up for your team and participate in the Leaders & Sponsors webinar track.

How did you hear about this Action Community?
Please list the emails of team members who would like to be added to the Action Community Listserv.
Team members:
Team members:
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Please note that you will need a clinical team to join the Action Community. If you are an agency, foundation, or other partner interested in joining the Age-Friendly Health Systems Action Community, please email ahaactioncommunity@aha.org to join our communications list.



Partners:

The John A. Hartford Foundation
The Institute for Healthcare Improvement (IHI)
Catholic health ministry of the United States