IA Health Link Kick-Off Meeting

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After completing this registration form, please submit the form as an email attachment by clicking on the “SUBMIT” b
IA Health Link Kick Off Meeting Registration Form The IA Health Link Kick-Off meetings will provide an overview of the IA Health Link program. Designed to appeal to a wide audience, the meetings will train community partners on the IA Health Link enrollment process and educate attendees on how to assist members through the transition and initial implementation of the program. Attend the meeting if you are a community partner, advocate, stakeholder organization, enrollment assister, certified application counselor, family member or someone who wants to learn about the program changes to assist Medicaid members.

Please select the venue and session you would like to attend. Space is limited. First Name

Last Name

Address City

State

Zip

Telephone

Contact Email

Organization Name

NPI (if a provider)

Schedule of IA Health Link Kick Off Meetings Workshop Locations, Dates, and Times Please selectaa meeting venue, date,to and time from the drop menu Choose attend from thedown drop down

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Are there any questions you have about the new IA Health Link program that you would like addressed during the meeting? We will try to accommodate as many as we are able. Thank you.

After completing this registration form, please submit the form as an email attachment by clicking on the “SUBMIT” button below. SUBMIT This registration form may also be submitted: By Fax:

(515) 725-1351

By Mail:

IME Communications P.O. Box 36510 Des Moines, IA 50315

For inquiries, please send an email to [email protected]