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Step
1
of
2
50%
Your Email
*
Organization Name
*
Organization Type
*
--Select One--
Hospital - Critical Access Hospital (CAH)
Hospital - Small Rural - 49 beds or less (non-CAH)
Hospital - Other
Emergency Medical Services Entity
Federally Qualified Health Center
FQHC Look alike
Local or state health department
Mental or Behavioral Health Organization, practice or provider
Primary care practice or provider
Rural Health Clinic
Ryan White HIV/Aids Clinic
Substance Abuse Treatment Provider - Methadone Clinic
Substance Abuse Treatment Provider - Opioid Treatment Program
Substance Abuse Treatment Provider - Other
Other medical agency or organization - Dental
Substance Abuse Treatment Provider - Pharmacy
Substance Abuse Treatment Provider - Telehealth
Community Based Organization
Cooperative Extension System Office
Criminal Justice Entity - Law Enforcement
Criminal Justice Entity - Court System
Criminal Justice Entity - Prison
Criminal Justice Entity - Probation / Parole
Faith based organization
Healthy Start Site
HIV / HCV prevention organization
Maternal, Infant and Early Childhood Home Visiting Program - Local Implementation Agency
Poison Control Center
Primary Care Association (PCA)
Primary Care Organization (PCO)
Recovery Community Organization
School System
Single State Agency (SSA)
State Office of Rural Health (SORH)
Tribe / Tribal Organization
Other / Non-medical - Child Welfare or Child Protective Services
Other / Non-medical - College, University or Research Organization
Other / Non-medical - Community Member
Other / Non-medical - Community Member with Lived Experience
Other / Non-medical -Employment Agency or Workforce Development Board
Other / Non-medical - Local Government Entities
Other / Non-medical - Transportation Related Entities
Other / Non-medical - other
Organization City
*
Address is in a HRSA 0 designated rural area?
*
Yes
No
Name of Organization's PRIMARY Point of Contact
*
First
Last
Title/Position of Organization's PRIMARY Point of Contact
*
Email of Organization's PRIMARY Point of Contact
*
Phone Number of Organization's PRIMARY Point of Contact
*
Organization Primary Phone Number
*
Organization Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Organization Website
*
Please indicate the counties which activities and or services are being implemented within.
*
Luce
Mackinac
Alger
Schoolcraft
Chippewa
Prevention Core Activities
*
Education Programs SUD/OUD
Awareness Campaigns
School prevention Programs
Community Prevention Programs
Prescription Drug Take Back programs
Provide Harm Reduction Activities
Treatment Core Activities
*
Prescription Drug Monitoring Programs
Safe Prescribing Initiatives
Professional training in SUD/OUD
Screening and referral initiatives
Naloxone access initiatives
Syringe exchange Programs
Expand medication for opioid use disorder treatment
Enhanced quality of care initiatives
MOUD Waivered
Provide EHO SUD/OUD Services
Provide Billing and Coding Guidance
Direct Patient Services
Expand treatment workforce
Expand SUD treatment in jails and prisons
Engaged in OUD/SUD Best Practices
Crisis Center or Services
Recovery Core Activities
*
Expand recovery support services
Partner of Recovery Housing Coalition or Collaborative
Provide Recovery Housing
Provide Recovery Support Programs
Support or Provide Recovery Employment
Transitional/Sober Living Housing
Other Activities
*
Support the location of SUD treatment resources
Improve insurance coverage for SUD/OUD care
Expand role of law enforcement in SUD/OUD care
Expand jail diversion programs
Initiatives to connect former inmates to treatment and recovery resources upon release of incarceration
Support SUD/OUD via small or large grant funding
Provide Training Programs for EMS
Provide Academic Detail Training specific to OUD/SUD
Family Support Networks
Perinatal Care and Services related to OUD/SUD
Maternal Infant Child Programs related to SUD/OUD
Participate or Collaborate in MSU Extension Services and Education
Participate in 3RNet
Instrumental in Policy and Regulatory Boards/Legislation Development
