PeerPlace® Demonstration Request

First Name:
Last Name:
Agency/Department Name:
Phone Number:
Email:
I am affiliated with the following agencies or departments:
State Unit on Aging
Area Agency on Aging
Perinatal Agency
Health Insurance Information Counseling Assistance Program (HICAP)
Community Action Program
CMS
DSS
DOH
Regional Health Information Exchange (RHIO)
Non Profit Service Provider
During my demonstration of PeerPlace, I would like to learn more about the following:
Master Client Database
Universal Referral Capabilities
The Tracking of Service Units and Outcome Measures
State and Federal Reporting Capabilities
List Reports you would like to cover
Information and Assistance
Program Enrollment
Event Tracking
Case Management Capabilities
Billing Capabilities