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Please fax your response by [DATE] to [FAX NUMBER] or e-mail [E-MAIL]. Name: ______________________________________________________________ Organization: _________________________________________________________ Address: _____________________________________________________________ Phone Number: _____________________ Fax Number: ______________________ E-mail: ______________________________________________________________ Areas of Expertise: _____________________________________________________ _____________________________________________________________________ ___ Yes, I will serve on the HVP steering committee. ___ No, I will not be able to serve on the HVP steering committee. |
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You can download this response form as a Microsoft Word file. Allow time for the download to complete. Your screen may be blank while download is in progress. After download completes you can save a copy of the file to your own computer for detailed study. |
This toolkit is provided by the Department of Veterans Affairs National Hospice-Veteran Partnership (HVP) Program. Development of the toolkit was made possible through support by Rallying Points, the National Hospice and Palliative Care Organization, the Center for Advanced Illness Coordinated Care, and other end-of-life care advocates. Information about VAHPC initiatives is made available for use within the Inter-Institutional Collaborating Network on End-of-life Care (IICN) with the assistance of Growth House, Inc.