HCSS Toolkit Download
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Thank you for your interest in The Joint Commission's Health Care Staffing Services certification program. By completing this brief form, you will gain access to a variety of tools to help you better understand and prepare for certification with The Joint Commission. Everything you need is here at your fingertips and in one convenient place!
For questions related to this form, e-mail
deickemeyer@jointcommission.org
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First Name
First Name
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Last Name
Last Name
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Title
Title
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Company Name
Company Name
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Street Address
Street Address
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City
City
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State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State
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Zip Code
Zip Code
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Telephone Number
Telephone Number
Fax Number
Fax Number
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E-mail Address
E-mail Address
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How would you describe your organization?
How would you describe your organization?
Hospital or other health care organization
Consultant
Health Care Staffing Firm
Other (please specify)
Are you currently accredited or certified by The Joint Commission?
Are you currently accredited or certified by The Joint Commission?
Yes
No
Don't Know
When would you be interested in receiving certification?
When would you be interested in receiving certification?
Within 6 months
6-12 months
12-18 months
Not sure
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