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UW ECHO Case Presentation Submission Form

Presentation Information
UW ECHO Network:
Presentation occurrence:
Case Type:
Please enter your phone number in the following format: 123-456-7890.
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
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Case Information Disclaimers

When we receive your case, we will email you a confidential identification number (ECHO ID) and confirm date and time for the case presentation. The provided ECHO ID must be utilized when identifying this case presentation during the ECHO session. Case presentation times may fluctuate depending on the availability of the professional development presenter. Times will be confirmed when the ECHO ID is assigned.

PLEASE NOTE: The UW ECHO case consultations do not create or otherwise establish a relationship between any of the UW ECHO experts or UW ECHO staff and any participant whose case is being presented in a UW ECHO setting.

The information provided as feedback are considerations only and not a formal assessment.
Case Information
What is your professional role? Check all that apply.