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Mentor Application
Please provide your name.
Please provide a short description of why you want to be a mentor and what you can contribute to the professional development of a mentee.
Please provide any special training or experience you have in the following areas: clinical / patient, and claims/ litigation. safety, risk financing, legal / regulatory,
Please indicate in which healthcare delivery setting you are currently employed:
Hospital
Ambulatory Surgical Center
Outpatient Clinic
Assisted Living
Behavioral Health
Health Maintenance Organization
Home Health
Physician Office Practice
Skilled Nursing Facility
