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Resource Submission Form
Contact Information
Hospital
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Partners
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Resource Contact Name
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Resource contact Email Address
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Can this email address be used to allow others to contact you about your program?
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Yes, other essential hospitals can contact me directly about my program.
No, I prefer to be contacted by America's Essential Hospitals if someone is interested in my program.
Resource Information
Resource Name
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Social Determinant(s) Addressed by Resource (select up to 3)
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2
3
4
5
6
Climate Vulnerability
Community Infrastructure
Education
Employment & Income
Family & Social Support
Food Insecurity
Health Behaviors
Health Literacy
Housing Instability
Interpersonal Violence
Legal Needs
Social Needs Screening
Structural Racism
Transportation
Utility Needs
Use Ctrl to select up to three
Primary Social Determinant Addressed by Resource
*
Climate Vulnerability
Community Infrastructure
Education
Employment & Income
Family & Social Support
Food Insecurity
Health Behaviors
Health Literacy
Housing Instability
Interpersonal Violence
Legal Needs
Social Needs Screening
Transportation
Utility Needs
Structural Racism
Please select one option
Strategy
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COVID-19
HIT Systems & Analysis
Hospital Readiness/Community Assessment
Multisector Partnerships
Program Implementation
Strategic Planning
Sustainable Funding
Workforce Capacity
Employee Engagement
Procurement
Please select one option
In 1-2 sentences, please describe the resource.
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In 1-2 sentences, please describe how essential hospitals can utilize the resource.
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Please provide an active link to your resource.
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