QuIIN-Form

​QuIIN Application

AAP Member physicians who are interested in improving the quality and delivery of pediatric care in a myriad of clinical settings with a commitment to being involved in QuIIN

AAP ID *


First Name *


Last Name *


Email Address *


Phone *


Please check which boxes best describe you (Check all that apply) *

If you selected Outpatient, Primary Care Physician, please enter Practice Name


If you selected Inpatient, Hospitalist, please enter Hospital Name


If you selected Specialist, please enter Specialty


Have you assessed quality of care using measures? *

Performance Measurement *

Quality improvement effort *

Please indicate your experience with quality improvement. *

   

Describe what you would like to accomplish by participating in the QuIIN. *

What makes you (or your practice/hospital) a good fit for QuIIN? *

Additional Comments *

Physician Leader Acceptance:


Captcha

Change the CAPTCHA codeSpeak the CAPTCHA code