MN Community Collaboration on Viral Hepatitis ECHO Case Presentation Form

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MN Community Collaboration on Viral Hepatitis ECHO Case Presentation Form

Please provide as much or as little information as you feel is relevant for case review.

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What is your name and organization? *

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What is your email address? *

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What is the key question, issue, or topic you would like to discuss with the group? What specific question/s do you have about the patient or scenario? *

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What is your timeline for a response on this case?

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This month

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