Adoption and impact reference panel membership form
Name
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First Name
Last Name
Job title
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Organisation
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Department/service area
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Work email address
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example@example.com
Phone Number
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-
Country Code
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Area Code
Phone Number
Additional contact information
We can routinely copy your PA if you provide an email address.
Which work streams are of interest? You understand that, as a panel member, you may be invited to contribute to the development of support resources relating to any of the following NICE workstreams. Your specific interests are:
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Adoption of technology
Resource impact assessment (costing,commissioning)
Implementation of guidelines/ guidance
Uptake of guidelines/ guidance
Areas of interest. Please check all that are applicable to you. Work area:
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Finance
Clinical
MedTech/dianostics
Workforce
Commissioning
Public Health
Audit
Social care
Care setting:
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Community care
Primary care
Secondary care/acute care
Mental health
Social care
Public health
Commissioning
Specific areas of knowledge, expertise or interest?
These are areas not previously listed that you’d like to provide comment on, or anything else you’d like to tell us. For example, clinical, management or specialist areas.
Signature
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Submit
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