The quick survey will ask responders to fill out the following information:
- Your specific qualifications and interest in being of public service in this regard.
- Your professional title
- List specialties or certifications
- Date of birth
- Are you a current practitioner?
- Last date of practice
- Role in last practice
- Date of most recent certification and license
- License number
- Contact Information including email and address
- Willingness to work in any region of NYS
- Describe your interest and ability to be able to provide your services to treat patients if the need should arise in the future.
- Any other information that is relevant as the state builds capacity in this regard, especially experience with infectious diseases, respiratory conditions, critical care, or emergency medical services or care.
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