Project ECHO Case Form | Minnesota Medical Association

Submit Your Project ECHO Case Study

Your name, credentials and practice location:

Your Email:

Provide a brief clinical summary of why you want to discuss the case â 5 to 7 sentences:

What help would you like with supporting this young adult transitioning to adulthood/into your practice?

What knowledge gaps exist around this issue?

Describe any health equity concerns you have relevant to your case:

Is there anything else you would like us to know?

Age:

Gender:

Diagnosis and Date:

Treatment and Significant Investigation to date:

Past Medical History:

ECHO ID: