database project

profilegopi
MasterParticipantList.docx

Master Participant List

Start Date:

End Date:

Host Partner:

UW/AAATC/Sixty and Better

Class Location:

POC:

Tina Dawson

Name

Participant ID*

Contact: Phone/Email

Managed Care Provider

1

None Given

2

None Given

3

None Given

4

None Given

5

None Given

6

None Given

7

None Given

8

None Given

9

None Given

10

None Given

11

None Given

12

None Given

13

None Given

14

None Given

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

Revised 9/17/2018

*Participant ID = first two initial of first name, first two initial of last name, last two digits of your birth year. Ex: James Doe born 1956 is JADO56