1. Name of Organization Location Type of site
You may include other info as desired (such as mission)

2. Who we serve Show us the people you serve! Photos (with permission)
Description of the population
% Medicaid
Other information as desired (languages spoken, special characteristics)

3. Our people Show us your leaders and staff! (photos encouraged!)
Identify members of the team attending the kick-off, by name and role

4. Our facilities Include photos of your facility/facilities.
Give us a virtual tour!

5. Our community
Show us the community where your facility/facilities are located (photos encouraged)
Tell us about the broader community you serve

6. Strategic Priorities

7. Prior Experience in Quality Improvement Initiatives or Collaboratives

8. PCMH-A or MeHAF
Paste recent PCMH-A or MeHAF results here

9. What we learned from the PCMH-A or MeHAF

10. Something we are proud of
Tell a brief story of something your organization has done to promote Whole Person Care that you are proud of.

11. Something we’d like to achieve
Describe something your organization is keen to improve towards improving Whole Person Care

12. Impact Story
Share a story of the impact that making changes in Whole Person Care have had (confidentially or with permission) or could have on your patient(s), families, staff, organization or community.