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: 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 channelsEx.: - 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 GillespiePlease 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.Please provide any other detail or background below. If you have any relevant documents, please upload them below.AttachmentsMax. file size: 5 MB.NameThis field is for validation purposes and should be left unchanged.
