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Starting July 1, 2025, you may have a new regional organization. You may also be assigned to a new primary care provider.
Your benefits and services are not changing.
Learn more about Accountable Care Collaborative (ACC) Phase III changes and how they may affect you.
Region 3 Program Improvement Advisory Committee
Region 3 Program Improvement Advisory Committee
Adams, Arapahoe, Douglas & Elbert Counties
Region 3 PIAC
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
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Armed Forces Americas
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State
ZIP Code
County
*
Email
*
Phone
*
Perspectives and Experience
*
We are required by the state to have a variety of perspectives and experiences represented on this committee. Please check all that apply to you:
Member of Health First Colorado (Colorado’s Medicaid Program)
Family member and/or caregiver of a Health First Colorado member
Primary care provider
Behavioral health provider
Specialist
Hospital
Long-term services and supports provider
Oral health provider
Nursing facility
Local public health
Community organization
Social service/human service organization
Advocacy organization
Present Employer/Occupation
*
Why do you want to participate on the Regional PIAC?
*
What health care issues are important to you and why?
*
What skills, experience, and perspective do you feel you can share?
*
If you are a member, family member and/or caregiver, how do you feel you represent the diversity of the Health First Colorado membership? (If this doesn't apply to you, please write "not applicable")
*
How did you hear about this region's Program Improvement Advisory Committee (PIAC)?
*
Demographic Information
A response to the following is optional, but is encouraged. The information will be taken into consideration when we select committee members in a good faith attempt to have equal representation from all demographic areas.
Gender
Male
Female
Ethnicity
Hispanic/Latino
African American
Pacific Islander
Mixed Race
Caucasian
Other
Certification
*
I certify that the facts contained in this application are true and correct to the best of my knowledge. I further understand that the Colorado Open Records Act may require that certain information contained in this application be available for inspection by the general public. Certify by checking the box below:
Yes