Thaj tsam 3 Program Improvement Advisory Committee

lub npe*

thawj xeem

chaw nyob*

chaw Nyob Chaw nyob Line 2 txoj kev xav State ZIP Code

County*

Email*

xov tooj*

Kev Tsim Tsa thiab Kev Kawm*

Peb lub xeev yuav tsum tau kom muaj ntau lub tswv yim thiab cov kev paub txog ntawm pawg neeg no. Thov kos txhua qhov uas muaj feem xyuam rau koj:

Qhia Txog Tus Tswv Cuab / Hauj Lwm*

Vim li cas koj thiaj xav koom tes nrog PIAC Regional?*

Cov teeb meem kev kho mob dab tsi tseem ceeb rau koj thiab yog vim li cas?*

Koj xav li cas, kev paub, thiab koj xav li cas koj thiaj paub?*

Yog tias koj yog tus tswvcuab, tus tswvcuab ntawm tsev neeg thiab / lossis cov neeg saib xyuas, koj xav li cas tias koj sawv cev rau ntau haiv neeg nyob hauv Health First Colorado ua tswv cuab? (Yog tias qhov no tsis siv rau koj, thov sau "tsis muaj feem")*

Koj tau hnov li cas hais txog Pab Pawg Txhawb Kev Tawm Tswv Yim Tswj Haujlwm thaj av Thaj Av (PIAC)?*

Cov Ntaub Ntawv Qhia Demographic

Cov lus teb rau cov hauv qab no yog nyob ntawm koj xaiv, tiam sis raug txhawb nqa. Cov ntaub ntawv yuav raug saib xyuas thaum peb xaiv cov tswv cuab hauv pawg ntseeg kom muaj kev ntseeg siab kom muaj kev sawv cev ntawm txhua thaj chaw.

Tub los ntxhais

Haivneeg

Certification*

Kuv lees tias cov lus tseeb hauv daim ntawv thov no yeej muaj tseeb thiab yog raws li qhov kuv paub. Kuv nkag siab ntxiv hais tias Txoj Cai Tswjfwm Colorado Cov Ntaub Ntawv Sau Tseg tau hais tias cov ntaub ntawv muaj nyob rau hauv daim ntawv thov no yuav tsum muaj rau kev soj ntsuam los ntawm pej xeem sawv daws. Sau rau hauv khij lub npov hauv qab no:

Yog

Thaaj Tsoom 3 Program Improvement Advisory Committee

Adams, Arapahoe, Douglas & Elbert Nroog

Thaj av 3 PIAC