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COVID-19: Clinician Placement Form

Complete the following information indicating your availability to treat patients at hospitals across the US during the COVID-19 pandemic. Once your application is received, it will be added to a resource bank to be matched with hospitals for potential needs. Telehealth opportunities are also available.
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This question requires a valid number format.
Are you a licensed medical professional? *This question is required.
This question requires a valid number format.