QI in Clinics Pilot Application

QI in Clinics Pilot

Please complete this form to express you/your team’s intent to participate in the pilot of the QI in Clinics program and to help guide you in your project selection.

Step 1 of 3

Clinic Details

Team Details

Teams will consist of a physician(s), a medical office assistant and/or office manager, who will lead a clinic-wide improvement project. Teams can have two to five members attend the virtual workshops.

Team Member 1


Team Member 2


Team Member 3


Team Member 4


Team Member 5


Program/project sponsor

Within the QI in Clinics program, a sponsor refers to someone who will assist reducing barriers to participating in the program and testing changes within your clinic. They may provide time-relief for you to attend the sessions or work on the project.