2020.07.07 Registration

This is the registration form for the Region 2 Public Health Training Center's Log-in2Learn webinar on July 7th, 2020 from 12:00 PM to 1:00 PM ET. The title of the webinar is "Buprenorphine Treatment for Opioid Use Disorder during the COVID-19 Pandemic" presented by Tiffany Lu, MD, MS, Assistant Professor of Medicine at Montefiore Medical Center/Albert Einstein School of Medicine.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email Address *This question is required.

4. Job Title *This question is required.

5. Organization *This question is required.

6. Which is the U.S. state/ territory/ commonwealth where you work? *This question is required.

7. Please select your employment setting (check all that apply) *This question is required.

Primary Care
Medically Underserved Community
Rural Area
None of the above

8. Please select your primary profession/discipline. *This question is required.

9. How confident are you that you can... *This question is required.

Space Cell	Not at all confident	Somewhat confident	Moderately confident	Very confident
Explain regulatory updates regarding buprenorphine treatment during a public health emergency	Explain regulatory updates regarding buprenorphine treatment during a public health emergency: Not at all confident	Explain regulatory updates regarding buprenorphine treatment during a public health emergency: Somewhat confident	Explain regulatory updates regarding buprenorphine treatment during a public health emergency: Moderately confident	Explain regulatory updates regarding buprenorphine treatment during a public health emergency: Very confident
Describe practice-level changes in buprenorphine treatment throughout COVID-19	Describe practice-level changes in buprenorphine treatment throughout COVID-19: Not at all confident	Describe practice-level changes in buprenorphine treatment throughout COVID-19: Somewhat confident	Describe practice-level changes in buprenorphine treatment throughout COVID-19: Moderately confident	Describe practice-level changes in buprenorphine treatment throughout COVID-19: Very confident
Discuss common issues affecting patients in buprenorphine treatment during COVID-19	Discuss common issues affecting patients in buprenorphine treatment during COVID-19: Not at all confident	Discuss common issues affecting patients in buprenorphine treatment during COVID-19: Somewhat confident	Discuss common issues affecting patients in buprenorphine treatment during COVID-19: Moderately confident	Discuss common issues affecting patients in buprenorphine treatment during COVID-19: Very confident

10. Please select the reason you are attending this training (please select all that apply) *This question is required.

to learn more about the specific training topic
the training topic relates to my work
general interest in staying informed about public health practice
general interest in staying informed about current public health research
general interest in staying informed about public health policy
to obtain continuing education credits
Other (please specify) Please enter an 'other' value for this selection. * This question is required.

2020.07.07 Registration

Training Registration