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Member Registration
ABOUT PHYSICIANS’ RESEARCH NETWORK PRN’s mission is to provide ongoing peer support to physicians, nurse practitioners and physician assistants providing care to people with, and at risk for, HIV disease and/or viral hepatitis. PRN is committed to improving the diagnosis, management and prevention of these epidemic viral diseases and their complications, and to enhancing the broad spectrum of skills utilized by our members.
* Username Usernames must be at least 4 characters long
* Password Passwords must be at least 5 characters long
* Password Confirm
* Screen Name If you leave this field blank, your screen name will be the same as your username
* Email Address
* Membership Type
Salutation
* First Name
Middle Initial
* Last Name
* Mailing Address
Additional Address Line
* City
* State
* ZIP Code
Country
* Telephone (Voice) Please include your extension if applicable.
Fax
* Meeting Announcements Send my meeting announcements by:
* Degree
Other Degree
* Medical License #
* State
* Board Certified?
* Specialty
* Are you credentialed in HIV medicine by AAHIVM?
* Are you a member of HIVMA?
* Are you a member of IDSA?
* Type of Practice
Other Type of Practice
* Location of Primary Medical Practice by ZIP Code
* Employer (name of individual, hospital, university or organization employed by, if applicable)
* In what position?
Other Position
* Hospital Affiliation(s)
* Academic Appointment(s)
* Testing and Screening for HIV/AIDS Does your practice include testing and screening for HIV/AIDS?
* Management of HIV/AIDS Does your practice include management of HIV/AIDS?
* Research Involving HIV Disease Does your practice include research involving HIV disease?
* Management of Complications Due to HIV Disease Does your practice include subspecialty management of complications due to HIV disease?
* HIV+ Patients Treated in the Past Year Approximately how many HIV+ patients did you treat in the past year?
* HIV+ Patients Treated in the Previous Year Approximately how many HIV+ patients did you treat in the previous year?
Percent of Your Total Patient Population is HIV+ Approximately what percent of your total patient population is HIV+?
Percent of Your HIV+ Patients are Black Approximately what percent of your HIV+ patients are Black?
Percent of Your HIV+ Patients are Asian / Pacific Approximately what percent of your HIV+ patients are Asian / Pacific Islander?
Percent of Your HIV+ Patients are Hispanic Approximately what percent of your HIV+ patients are Hispanic?
Percent of Your HIV+ Patients are Native American Approximately what percent of your HIV+ patients are Native American?
Percent of Your HIV+ Patients are White Approximately what percent of your HIV+ patients are White?
Percent of Your HIV+ Patients are Other Approximately what percent of your HIV+ patients are other?
Percent of Your HIV+ Patients are Male Approximately what percent of your HIV+ patients are Male?
Percent of Your HIV+ Patients are Female Approximately what percent of your HIV+ patients are Female?
Percent of Your HIV+ Patients are Trans Approximately what percent of your HIV+ patients are Trans?
Topic of Focus for PRN Meeting Name at least 1 topic you would like to be the focus of a PRN meeting this year:
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