Communication Requests Requester Email*Please enter an email to receive information regarding your profiles progress. 1. Purpose of communicationDepartment(s) announcing a change in practice:Please click on the + icon to add additional departments. Department(s)/Programs impacted by this change:Please include your location (Boston/Waltham/Peabody/etc.) Click on the + icon to add additional departments. Effective date of change: Date Format: MM slash DD slash YYYY 2. Primary/intended audience:Who is the primary audience of this communication?Please select all that apply below: Referring providers Patients & families Internal staff Other (please specify below) 6. What are the preferred distribution channels?Ex.: - Internal Channels (Web2/Scope360/Digital Signage) - External Channels (Social Media/Email/Patient Prompt/Blogs) - Childrenhospital.org - Patient PortalPlease click the + to add more channels 3. Who should the communication be signed by or sent from?Please include individual's name and email on each line. To add additional lines, please click on the + icon.Ex: All COVID re-opening correspondence is signed by Michael Gillespie 4. Key Message Points - who, what, where, when, why and how?4a: Who4b: What4c: Where/When4d: Why/How5. What other marketing/communication support is needed?Please provide details below:ex: website updated, social media posts, posters, etc.7. Any other relevant background:Please provide any other detail or background below. If you have any relevant documents, please upload them below.AttachmentsNameThis field is for validation purposes and should be left unchanged.