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COVID19 VACCINATION INFORMATION
QUALITY AGING MATRIX
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Members Survey
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Indicates required field
Name of Organization:
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Which counties does your organization serve? (check all that apply)
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Lapeer
Livingston
Macomb
Monroe
Oakland
St. Clair
Washtenaw
Wayne
Please provide totals covering a full 12 month period of time.
How many older/disabled adults does your organization serve (including their caregivers/family)?
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How many OTHER individuals (excluding older adults, caregivers, etc.) does your organization serve?
*
Submit