Share Your Success Story

Please complete the brief questions below to submit your Care Management, Team Based or High Intensity Care Management success story.

1 Start 2 Success Story Details 3 Complete

First Name *

Last Name *

Email Address *

Licensure

e.g. RN, MSW, etc.

Job Title

Employer Type *

Employer Other *

If other, please indicate type of employer

Employer Name

Program Other

If other, please indicate the program

Contact Preferences *

What is your preferred method for a member of MiCMRC contact you for more information about your story?

Phone Number *

Please indicate your daytime phone number.

Success Story Type *

Care Manager

Team Based

HICM

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