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Putting the Charter into Practice Grant
F. Daniel Duffy Small Grant
Duffy Grant Form
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F. Daniel Duffy Small Grant
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Duffy Grant Form
Will you use an ABIM PIM?
Select
Yes
No
If yes, what ABIM PIM will you use?
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Asthma
Care of Vulnerable Elderly
Clinical Preventive Services
Colonoscopy
Communication - Primary Care
Communication - Subspecialists
Communication with Referring Physicians
Diabetes
HIV
Hepatitis C
Hospital-Based Patient Care
Hospital - Prevention of Ventilation-Associated Pneumonia
Hypertension
Osteoporosis
Preventive Cardiology
If you are not using an ABIM PIM, is there a specific QI tool that you will use and evaluate?
Trainee 1
First Name
Last Name
Post graduate year level
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PGY-1
PGY-2
PGY-3
Fellow
Other
If other, please explain
Email
Phone
Future career goal of trainee 1
Trainee 2 (if applicable)
First Name
Last Name
Post graduate year level
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PGY-1
PGY-2
PGY-3
Fellow
Other
If other, please explain
Email
Phone
Future career goal of trainee 2
Principal Investigator
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Last Name
Title
Email
Phone
Name of training program
Address of Training Program
City
State
Zip or Postal Code
Country