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Music & Memory Phase VI - Nursing Facility Nomination

The purpose of this questionnaire is for nursing facilities to nominate themselves to be considered for participation in the HHSC Music & Memory program. This program is limited to Texas nursing facilities only.
1. Is your facility currently participating in the Music & Memory program? *This question is required.
2. Is your facility receiving any Civil Monetary Penalty (CMP) funds to implement a Music & Memory program? *This question is required.
In order to be nominated, you must agree to all of the following:
3. Are you willing to accept and/or recruit volunteers to assist with the Music & Memory program in your facility? (For example: community organizations, high school students, college students) *This question is required.
4. Do you have 3 staff members who can serve as contacts and be responsible for implementation of the Music & Memory program? (Such as the Activity Director, DON, Administrator. One of the three must participate in ALL monthly webinars related to the Music & Memory program.) *This question is required.
5. Do you have a minimum of 15 residents who will participate in the Music & Memory program, at least 5 of whom have a diagnosis of Alzheimer's disease or another form of dementia? *This question is required.
6. Are you willing to expand the Music & Memory program to other residents in the facility (beyond the initial 15 residents)? *This question is required.
7. Are you willing to participate in mandatory 1 hour monthly webinars related to the Music & Memory program? *This question is required.
8. Are you willing to share data with HHSC regarding the impact of the Music & Memory program in your facility? *This question is required.
9. Are you willing to attend a mandatory 1 day meeting in Austin mid-July 2019 for the Music & Memory kick-off meeting? More information about the program will be presented, and facilities will receive the equipment necessary to participate in the program at that time. *This question is required.
10. Please provide us with more information about you and your facility. *This question is required.
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid email address.