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Thank you for your interest in Midwest Regional CAC's Peer Review Program.

This program runs from January 1st through December 31st of each year, and the cost to participate is $150 per center per year. It is the expectation that your center will participate in this program for the entire year and that your site will participate in your selected session/core community except for extenuating circumstances to ensure enough sites and fruitful conversation during peer review.
 
Please fill out the registration form on the following screens and pay the registration fee following the instructions at the end of this form. For tips to guide you through the registration process, visit bit.ly/2020PR

If you have any questions about the application, please contact Kim Martinez, Program Manager, Medical Academy & Peer Review, at kim.martinez@childrensmn.org or 952-992-5278 (office) or 612-759-9344 (cell).

Registration


Returning Site

If you answer No, we will carry forward ALL of your 2019 information into 2020. You will not have to complete the full registration form, only the payment portion. Please only select No if you expect to demonstrate full participation in your 2020 core community/communities.

Please verify that this information is correct for your organization and make changes, if needed. 
Organization Information




Who will be the primary contact from your organization regarding peer review?
 

The primary contact is the main point of contact regarding your organization's participation in peer review. The primary contact is responsible for forwarding all links and other communication to team members.

Peer Review Contact Information
Please select the type(s) of peer review your CAC is interested in participating in:

Medical Peer Review

Medical Peer Review Session Selection
Medical Peer Review will take place on the days/times listed below.  

Your site will need to choose one of these times to attend on a consistent basis. 


Each site will be required to present on a rotating basis, typically 3 times a year. 


If you agree to the conditions above, please indicate a first and second choice for the Medical Peer Review sessions in which you wish to participate. 
First Choice Second Choice
Primary Contact

As a reminder, the primary contact is responsible for forwarding all links and other communication to team members.
Medical Peer Review Primary Contact

Medical Peer Review

Medical Peer Review Participants
Please list the names, email addresses, and credentials of any/all medical providers who will be participating in Medical Peer Review with your site in 2020. 
First Name Last Name Email Address Credentials (DO, MD, NP, PA, RN, SANE-A, SANE-P, NA, Other)

SANE Peer Review

SANE Peer Review Session Selection
SANE Peer Review will take place on the days/times listed below.  

Your site will need to choose one of these times to attend on a consistent basis. 


Each site will be required to present 2-3 times during the annual cycle. 

 

Primary Contact

As a reminder, the primary contact is responsible for forwarding all links and other communication to team members.
SANE Peer Review Primary Contact

SANE Peer Review

SANE Peer Review Participants
Please list the names, email addresses, and credentials of any/all medical providers who will be participating in SANE Peer Review with your site in 2020. 
First Name Last Name Email Address Credentials (DO, MD, NP, PA, RN, SANE-A, SANE-P, NA, Other)

Forensic Interview Peer Review

Forensic Interview Peer Review Session Selection
Forensic Interview Peer Review will take place on the days/times listed below.   

Your site will need to choose one of these times to attend on a consistent basis. 


Each site will be required to present at least once during the annual cycle. 

 
If you agree to the conditions above, please indicate a first, second, and third choice for your day/time preference. Every effort will be made to accommodate your first choice selection. 
Forensic Interview Presentation Slots

Primary Contact

As a reminder, the primary contact is responsible for forwarding all links and other communication to team members.
Forensic Interview Peer Review Primary Contact

Spanish Speaking Forensic Interview Peer Review

Spanish Speaking Forensic Interview Peer Review Session Selection
Spanish Speaking Forensic Interview Peer Review will take place on the days/times listed below.   

Your site will need to choose one of these times to attend on a consistent basis. 


Each site will be required to present at least once during the annual cycle. 



Primary Contact

As a reminder, the primary contact is responsible for forwarding all links and other communication to team members.
Spanish Speaking Forensic Interview Peer Review Primary Contact

Interviewing Individuals with Disabilities Peer Review

Interviewing Individuals with Disabilities Peer Review Session Selection
Forensic Interview Peer Review: Interviewing Individuals with Disabilities will be held on the third Thursday of the month in April, August, and December of 2020 from 1-2:30 pm Central. There will be presenting sites with back-up sites assigned for this call.  

Your site will need to choose one of these times to attend on a consistent basis. 


Each site will be required to present at least once during the annual cycle. 



Primary Contact

As a reminder, the primary contact is responsible for forwarding all links and other communication to team members.
Interviewing Individuals with Disabilities Peer Review Primary Contact

Forensic Interview Peer Review Technology

Technology Requirements




Payment

Thank you for registering for 2020 Peer Review. The final step to complete your registration is to submit payment.

Credit cards are our standard and preferred method of payment. If necessary, we can also accept payment by check. 

Credit card payments are processed through PayPal. If you do not already have a PayPal account, you will need to establish a (free) username and password in order to process your credit card payment.

For sites who have pre-arranged an alternative payment option, please mark the Check option. 
If you have questions about payment, please contact Kia Kehrer, Program Coordinator, at kia.kehrer@childrensmn.org or 952-992-5276.  
 

When paying by check, please follow the instructions below. These can also be found on the peer review registration guide at bit.ly/2020PR
  1. Make check out to: Children's Healthcare
  2. Input in memo line: STPL/140101/91032. If your organization name is different than the account name on the check, please add your organization name in the memo line as well. 
  3. Send checks to: 
Midwest Regional CAC
CBC3-MWOUT
5901 Lincoln Drive
Edina, MN 55436

A copy of our W9 can be found at bit.ly/2o4qzd7 for your reference. 

By clicking Submit, you are completing this portion of the registration and agree to submit your payment by check before participating in the 2020 program. 

After you click Submit, you will be redirected to the payment form.