Event: CDC s NHSN Facility Set-Up Webinar Event Started: 9/21/2016 11:00 AM ET Please stand by for real-time captions. Good morning everybody, we are going to get started. My name is Maureen Marsella. I will continue to today's webinar. Thank you for your participation in the nursing home quality care corroborative. Today's webinar today will focus on the second page of the NHSN Facility Set- Up. We will cover the three steps on the second page of the checklist. Next week on September 28, we will hold weekly phone calls for additional information and discussion that reinforces the steps. It allows you to ask questions related to where you are in this process. One of the sold count -- calls will focus on the additional items on page 2 of the checklist NHSN reporting. It may be converted into webinar format if we find that appropriate. Please take note of the state leads contact information on the screen now. We are here to assist you in a one-to-one basis. Do not hesitate to call us directly. Before we get started I will quickly review a few housekeeping items. This call will be recorded for training purposes. Last week's call was recorded. I will tell you, there is an echo in the background. We have changed rooms and I hope that will correct that problem. I will provide you with the details on accessing the recording at the end of the webinar. The phone lines will be muted for the duration of the presentation. If you have to leave the presentation, please do not put us on hold, because we could possibly have you unmuted. Please just hang up and dial back in. We will have questions at the end. I will provide you instructions on how to unmute your phone line. You may post questions during the presentation in the chat box on the bottom right of the screen. The questions should go to all participants. That way we can keep up with the incoming questions. On the first slide here you see all of our contact information. Here is your Bible. The NHSN Facility Set-Up and enrollment checklist. Today we will focus on page 2. You can also get this if you go to the link at the top of this page and download. Again, I cannot stress enough, if you follow the facility start -- set up step-by-step and enrollment, you will be quite successful in doing all of these tasks. Facility set up prepares your long-term care facility to report to NHSN. I will tell you as they did last week; these are very step-by-step slides. I am going to be reading directly from the slides. This training is for any person planning to report infection from their long-term care facility into NHSN. Most often it is the facility administrator for the facility. Any person working with one or more facilities to prepare them to report into NHSN can also be in the audience, trainers, consultants, or NHSN group users. What are our objectives here today? Today we will cover how to navigate within the NHSN website, describe the two required steps in the process which are mapping locations within your facility and using CDC facility location description and creating monthly reporting plans. Then we will describe how to add other staff to your facility as an NHSN user and we will introduce the feature of joining a group. Set up follows NHSN enrollment. If you were on the call last week and you started this, I congratulate you. Once you have done the NHSN and agree to participate and consent to process, NHSN will send you an email and confirm enrollment is complete and your facility is live within NHSN. This is what the email will look like. Immediately following facility activation, you can log to the partner portal to access NHSN -- NHSN Reporting using the grid card you received in the mail. Do not lose that grid card. You will have that for the duration of your process using NHSN because that is
how you will get into NHSN websites. Set up is required before data can be reported into the NHSN Reporting website. You need to do three things. You need to add locations, add monthly reporting plans and end-users and assign rights. What does it mean to set up my facility in NHSN? Once you have completed that enrollment process and became an active NHSN facility, there are a few steps to complete in order to report infection directly into the system. First, describe all of the units where residents are located throughout the building. That is called mapping location. This allows you to see if infections can be clustered within one place of your facility. Second in importance, inform NHSN which events you are planning to track by completing the monthly reporting plan. The setup process walks you through these steps. NHSN navigation. What is NHSN navigation? The next few slides show you how to access NHSN from the SAMS portal and navigate into the live NHSN website. If you are a user for more than one facility, you can select the facility for which you are entering information from the NHSN landing page. What do I do? To enter the SAMS portal to enter NHSN. Go to tttps://sams.cdc.gov, then you will see the familiar page pop-up. You will click on the middle section of the page because you have a live active grid card with credentials. You click on that and login. You will then use your SAMS grid card username and password. Some tips: I suggest you use Internet Explorer. I've tried to use other browsers and they kick you out, they are not good browsers for this site. I suggest you save the website as your favorite. Set these websites as favorites because you will probably be using them monthly. The reported one is a must. When you log into https://sams.cdc.gov, set the site as a favorite. Here are the long-term component resources or you can get all the resources that NHSN has for long-term care. The long-term care component training resources are also there and brings you directly to the training resources. If you have time to play around in the website, you will see terms of tools you might be interested in. This is how you save your favorites as favorites. Once you have begun the process, you get to this page. You now click on NHSN Reporting where the red arrow is. That will bring you to the NHSN landing page. Select the component from the drop-down menu. All facilities that you have access to will show up in the drop-down box. Long-term care facilities can report into both the long-term care component for tracking infections, this is the component you will use while you are participating in this CDI project. You also have the opportunity to put healthcare personnel safety components for tracking your staff influenza. Like I said, that is not required for this. You will see the two arrows and dropdown to the long-term care component. Your facility name will come up. Then you hit submit. That will bring you to the long-term care facility component homepage. I want to look to the far right. This is the navigation bar in light blue. The options allow you to move from one section to another within NHSN. It lets you see different options on this navigation bar because you have different rights and actions that are allowed for each person. Don't get concerned. I will tell you the highlights of what you need to get this completed for set up. Important notes about the NHSN website: always use the navigation bar or the NHSN button to move from each page. If you use
anything else, you will be kicked right out of the site and you will have to start all over again. Do not use the Internet explorer web browser button. Again you will be kicked out. We want to move forward with mapping our location. Most long-term care facilities have different physical locations were residents reside and where they receive care in their building. These might be known as units, floors, neighborhoods depending on your individual facility. Each resident care location in your facility should be mapped to a CDC location code description. This provides information about the type of care the resident receives in that place. When reporting infection, the resident care location is used to identify where the resident was in the facility at the time the event occurred. Adding a location. I want you to look over to the far left side of that screen. This is your longterm care facility component homepage. You will see the navigation bar. Click on facility. The bar will expand and you then click on locations. Once you have done that, it will bring you to the locations page. You must make sure that you fill in anything that has a red asterisk near it because it is mandatory. How do you define each location within your titles? This means that for East location, NHSN asks you to create your own location code and label. Users in the facility will recognize the location. You will create a code to help you easily identify the location which is the name that the facility currently uses. For example 100 E., West Hall, South Hall, etc. This will help you easily identify the location. This would be any additional information you would like to add above the location control access (dementia unit). Your code and label can be the same for both. It does not have to be two separate code and label names. It could be West Hall and West Hall. You are the one who determines these. You're not getting get that from NHSN. You will decide the code and label and enter those in the boxes highlighted in red. Now you will move on to the CDC description. CDC location description is a drop-down box that provide you with CDC defined options for describing this location. Choose the appropriate CDC location description that best describes the resident population of the unit. For description of the CDC location for long-term care, you can visit the site below. That site will give you a full booklet and description of what the location should look like. Again you can see the CDC location dropdown provides all the possible units specific to long-term care facilities. Here is where you will choose the best description for the unit you are now mapping. You will then see below the CDC location, a description status. The status will default as active. Leave this as is. This is now an active unit you want to add. The next thing is bed size. This is optional and should include the number of beds that are set up and staffed. That means that you have beds and that within 24 hours you can have staff in there to take care of those patients. Don't forget to add -- click the add button. Once you do the code, label, CDC description, you have to click on add. If you do not you will lose everything you just did. What will come up is a location table. As you can see below, this is what it will look like. You will go back and continue to do this with all the units that you intend on putting into NHSN. The next slides will talk about location codes and descriptions which we discussed earlier. It gives you more definition. This is the description from CDC on what resident location codes look like. The list with the descriptions can be found at NHSN under the long-term care facility section, beginning on page 28. Here is the link if you want to download that. If you want to download the whole guide, here is what it would look like. At the hospice unit, the second and
third column, NHSN will assign. You will determine which unit is for example a dementia unit -- if you provide specialized care for individuals diagnosed with dementia or related conditions including Alzheimer's. So if that fits your residence, than that is the location description you choose or 100 E. If you choose 100E, this is short-term. You have skilled nursing, short-term nursing, ventilated, and geriatric. Here are additional tips on selecting a CDC location. To map the appropriate location units or the location codes for the units, review the resident mix in that unit during the previous year and choose the location code that best describes the type of units care service delivered on that unit. NHSN has an 80% rule. Sometimes more than one type of resident receives care at a location. For example, long stay and skilled resident beds are sometimes mixed together. The location code should reflect how the majority of residents cared for on that unit. Ideally, the code would apply as the following: if you have 20 patients and 80% are skilled patients, that is what you should use. If there is not a clear majority, select the code that makes sense to you in your facility. We will go over this again. Go to the navigation bar. Select facility. That opens up the select locations. Choose the code and the label. You will create these yourself. They can be the same. That is not a big deal. Your code and label is in there to help you easily identify your location. The CDC location selection is selected by the drop-down menu. The status will default automatically to active. Leave as active. Bed size is optional and includes the number of beds on the unit that is set up and staffed. We have a question. What if I did not receive a card? All I can say is that that I hope you applied for the grid card and did all of that. If you have done all of that, you have to email https://sams.cdc.gov and tell that you did not receive your card at samshelp@cdc.gov. Has it been 2 to 3 weeks? That is about how long the process has been taking. Once they receive all of your paperwork, they are telling us that it takes a good three possibly even four weeks right now. It is getting closer to the deadline where people have to be already enrolled in NHSN with a SAMS card. If it s not been three weeks, do not panic yet. Just send a request to us. I hope that answers the question. Is that it? Yes. We will open up the lines again at the end of this. Rest assured we will try to answer every question. Let's move on to the monthly reporting plan. The second process that you have to know to get yourself ready for reporting is to create monthly reporting plans. What is a monthly reporting plan? The monthly reporting plan tells NHSN which modules and defense at your facility will be tracking for the month. You must submit a monthly reporting plan for each month you want to perform surveillance in NHSN. If you are not using surveillance that is not what the expectations is. The expectation is from October 2016 moving forward to the end of this contract you will be submitting monthly data into NHSN for your CDI. You can set your whole plan up here right now. You can submit that monthly reporting plan for the whole year in advance. I will
show you how to do that. Monthly reporting plan options. You need to be concerned only with the number one on this screen. Choose a specific plan which includes selecting from the following options: those participating in the project, skip to number two box which is lab ID. C. difficile.that is where you will start to enter your data. Again, you are doing that in surveillance modules. For this project it is lab ID C. Go to reporting plans, that will expand and click on add. Select the month and year of surveillance. Complete the report. Step three is to complete the reporting pod. Here you will select the organism from the drop-down box for lab ID. That is what it is going to look like. Go over to the navigation bar on the left and click on reporting plan. It expands. Click on add. We do have the option to find and I will tell you about that later. To create a new plea plan, click on the expanded box again. Select the month and year. This brings you to the add monthly reporting plan screen. Anything that is in the red asterisk is required. You have to choose the month and year for which facility will be doing surveillance. To stop the project you're going to put in October 2016. You can move down. I will skip over this module. Move down to the lab ID event module. This facility is doing lab ID event surveillance. You are going to select the specific organism type and drop-down to the very last one which is facility wide inpatient. They're going to get to this CDI C. difficile. Intergraph that box in the right-hand corner. This is what your facility will be. You only have to do that one -- if you're going to do the hand hygiene, you go to this. Go to the bottom of the screen and click save. You will then get that cute little box with the green check in it the says plan saved successfully. Now you have done it. You have now created your plan for October. Remember I told you can do this for a whole year. This particular facility wanted to submit February 2015 data for urinary tract infection for C. difficile and MRSA. They did the drop-down in the module for inpatient. For lab ID they did staff wide inpatient, select CDI, then MRSA, then gloves and hit save. That is what the monthly reporting plan would look like for February 2015. To modify a plan you can always go in and find and edit. This is how you will do the continuation. You go in and go back to reporting plan, find, it drops down the January report. What you would do is go down to the middle of the screen lab ID, events module. You can see circle in that copy from previous month. You can set up a monthly reporting plan and copy the same selection for future months as you move forward. You can do that for up to 12 months. We have a question. Someone wanted to clarify that for the nursing homes, they are only tracking C diff? For this project that is all that they are tracking. I don't know what any other states are doing. There could be a Massachusetts -- and we will get to that also. There could be that the Department of Health of Massachusetts will be asking them for other information. I don't know if other projects are asking for this. For our project right now, we are doing CDI. Monthly reporting plan options. You don't have this option long-term component followed this month because the expectation for this project is that you will submit monthly data into this website for month -- months from October 2016 through the completion of the project in August 2019. NHSN users, I will add users and assign rights. You can add additional users to access. They are always optional and is strongly recommended that you have at least one additional user in your facility in case of illness or someone might have to go on an extended vacation and be gone for a month. You never know what could happen. You don't want to be left out there having to go through the entire process all over again, you will have no access to the database.
Unfortunately, we cannot enter any data for you. That all has to be done on your end. Your participation is you have a responsibility so I suggest you have more than one user. It is the facility administrator who assigns rights to each user. That facilitator can add or delete any data for the facility as well as adding the users. Once a new user is added, an email is automatically sent to their email address with instructions. Each user must register for access to SAMS and submit identity proofing documentation like all of you have done in the last few weeks or are in the process of doing. In that process you get your SAMS card and that is your card for life. Each user must complete training for using the plan. For this enrollment form, I would say that you should give them the Bible, as I call it, and let them go through the list. Doing those specific step-by-step things get them more acquainted with NHSN. How does a facility add a user? The first step is from the navigation bar of select users. That opens up and you select add. Once that opens up you come to the enter user information. Enter a username. The email address must be the same one used to request their SAMS card invitation. I don't know what you do, I know some nursing homes have a shared email address. I don't know what to tell you. This is the email that will be used for the invitation and etc. Complete all required fields. Then as always, click the save button. If you do not, you lose everything. What will come up is the third step and that is to assign the rates by checking the boxes under the long-term care session. For that, click save to save that data. This is what it looks like. Go over to users. The user expands and click on add. The user ID--create a user ID for the new user and fill in the mandatory box. They will then get the invitation. I want to stress again, same email for SAMS registration. Hit save. You must always hit the save button when you're finished entering all the user information or you will lose all the information you just typed in. Step three, the edit user right page will come up. The green check in the box shows you have successfully entered someone as a user. Now you have to give them rights. And the rights are in the far left. Administrator, all rights, analyze data. You may do everything on paper and have your secretary enter data. She could do all the rights or analyze the data. You may have analyst within your facility that can look at data and not do any submission of data. You decide what is the best thing for you and make sure you click save. To deactivate, this is an important thing, when a person has a SAMS card, they will have access to any of the areas that someone has given them access to. It is necessary for an administrator for your facility to deactivate any persons in a facility that leaves so they do not have access to your data. Go to the same user and navigation bar, click on find. At that point, it will bring up the page and you can type in the person if you know the user ID or remember what it is, or you could type in their home name and click find. At the bottom you will see the user list. It looks as though John Brown has left the facility. He was the director of nurses. The administrator wants to deactivate him. You can see up in this grid that at step three you select user and deactivation button and hit the save add. That will eliminate that person from your user list. Setup is complete. You are now ready to begin using. You have mapped all your locations that you want to report on. You have created monthly reporting plans for every month going forward for a full year. You patted users and assigned rights within your facility. The next step for you is to begin reporting. We are not going to talk about reporting just yet. You do not have the data because we have to finish October to have all the data. I will not go into any of that until later on in a couple of weeks. Let's talk about NHSN groups. Another set of options is joining a NHSN group. Any entity can maintain a group within NHSN. As corporate chain, a QIO -- I will tell
you that the QIO wants to have troop -- group wants -- wants to have group. The national coordinating center wants to have a group. You can't within your own organization. I have two or three nursing homes in a corporate chain. You can set up a group of those nursing home--two or three nursing homes, it doesn't matter--you can have it within your own corporate chain to have s user group also. What you need is the attorney password provided to the group. After joining, it'll show which data the group wants the facility to share. The facility must then press the accept button on the right screen to share the data. Each facility that joined the group does not have access to data from other facilities within the group. Only the facility administrator can see everyone's data. To clarify, in the nursing home world, there is a nursing home administrator. I want to clarify that when you are a talking administrator you are talking the administrator of NHSN not the administrator of the facility. It could be the same person, but it may not be. You have to decide who your facility administrator in NHSN will be. It could be the administrator of the facility, but I am not sure that is really what it will be. It is probably going to be your infection prevention. You may have a small facility and the administrator may want to do this. There is another question in the chat. If I leave a building and go to another building, do I have to start over or is my SAMS good wherever I go? Do have to surrender my card to my facility? I do not believe so. That is why there is deactivation. You would be deactivated from that facility. Then you would get reactivated as a new user in the new facility. You've already gone through that process of identifying and proofing. You would just need to be a user within the next facility. I am going to double check on that. I am not 100% sure about it. I know that I can use my SAMS card to get into multiple sites here at Healthcentric, but I have access to all of those. But I do not 100% know that. My thought process is saying the SAMS card is going to be able to have user rights within a facility to use the same card. But we will check on it. Are you writing that down for me? I did. Thank you. Hopefully next week we will have an answer for that. Let's go into how to create a group. This is a little confusing for people. Becoming part of a group can allow you to receive assistance from people at the Quinn. You can get the Department of Health in your state to help troubleshoot your data and for questions and errors. It allows the facility to share data with corporate management or colleagues. I know for some hospitals, they have a system for multiple hospitals with individual infection prevention within the hospital and a system-wide prevention. There is a group setup within the three hospitals I am speaking of. It allows a facility to share data within infection prevention or a quality collaborative. A facility can receive consultation from experienced users in other states or any user of that group can get help. I go into NHSN and I think I learn something new every day.
One of our associates provided the answer to the last question. Your SAMS account goes with you. It is up to the facility to pull you off of the account. It is up to the new facility to put you in as a user. Thank you, Reggie. This tells you about all the groups for this particular group in the New England region. It is a little confusing because we have to separate -- we actually have four groups you could join. For New England, Maine, Massachusetts and Rhode Island people you will join the Quinn and the MC CMS group. For Vermont, you will join New England spelled-out Quinn group and the NCC CMS group. For Massachusetts only, you are going to also confer rights to. Remember these are the idea group numbers and in the third column are the group joining passwords. I'm not going to tell you to print this. Tomorrow you will receive grants that are only for your specific state so you won't see all of these other ones that you do not need. So be on the lookout for your state leaders. Janet was not able to be here today, but she will email that out. The state leaders will in turn mail the nursing homes tomorrow, so you would be able to see who you should confer rights to. Then Connecticut New Hampshire and Vermont. What does it look like? Go back to your membership page and to your landing page. You will click on the navigation bar groups. That will then expand. Click on join. You will then enter the ID and passcode for this facility to join the group that they want you to join. We want to join the third one down in the row in the column here. The first column is NCC CMS. All of the New England nursing homes have to sign onto that. In the group ID, put the 38648 in the first box. Once those are in there, click join group. That will then bring you to what is called the Conferred Rights Template. If you look at the middle box, please review the data rights for region three New Hampshire to IL. It will look like this. I did one for Rhode Island. I probably shouldn't do the NCC one. You will get the dividing rights box that will say Facilities when joining the New England QIL. You will see the NCC, and that is what you have to join. The only thing you have to do at this point -- I should've done one for the NCC. I apologize for that. You have to do is go to the bottom of that screen and click accept. You have now accepted these groups. These groups can now see your data. This is how they are going to be able to track, trend and look at how we do in our progress in this task. We have now completed how to set up a facility, how to get the groups and to be able to enter data. If you have any questions, there is the online help manual. You can click where the arrow is to get that. And always at NHSN@www.cdc.gov. You can get information there as well. Please save this. This is an important email to have saved in your computer. If there are any changes in your email address, please let them know that. Let's do a summary. You know how to add NHSN website to your favorites. You have an idea of how to use the NHSN navigation. You have learned today how to map long-term care facility locations. You know how to create a monthly reporting plan. You know how to add users and assign user rights. You have learned how to join groups. You know that this is your Bible and we now have completed most of page 2 except for the very bottom of reporting into NHSN. We will do that at a later date and at same the time, have open calls from September 28 through October 26, every Wednesday at this time from 11 to noon. It will be an audio. I don't believe there is going to be
any website unless we do feel that in the reporting of data that we need to have some type of a website. Then we will. I think we can now open up the lines. There is a question. Can the user be given the right to add or edit other users? Or is that only possible for the administrator? I believe if you only have all rights if you are an administrator. What does all rights mean? I think it means everything else except for the administrative right. Actually now that I think of it, you may be able to get all the rights also. You may not be considered the contact person, the facility administrator is usually the contact person. I would have to play around with that. I have never had to worry about that because I have always been an administrator. Maybe Reggie can tell me. To unmute your line and ask a question, press pound six. Anyone can ask that question. Reggie if you know the answer to this -- if not, we will write it down and I will double check that all rights does ultimately give everybody the ability to add and delete users. The next part of that question was can we have more than one administrator? You should only have one administrator. I do know places have to have administrators. Another question. Can you go back to the slide with 928 to 10 six -- for the contact in the code? This here? The weekly phone call? This one here? This is the one. This is the weekly open office call. You can call in and ask your questions or get support without having any scheduled time or playing telephone teag with anyone. You'll get your questions answered on-line. If you have a question you can ask it via the phone. Press pound six to ask your question. Question: Will this presentation be emailed? The recording will be available on our websites. The slides were emailed yesterday morning. The presentation recording live transcript, and any important contact information will be available on our website. That link has been included on the email invites. An email will be sent out tomorrow with the evaluation and the URL website link to find all of these materials. Any more questions?
Reggie responded that there is only one administrator, but there can be several other types of users. Reggie, I don't know if that implies the other users have the ability to add or edit users. Or is that only the responsibility of the NHSN administrator? We know that it is the responsibility of the NHSN administrator. I don't know if you have all rights if you could also can get in to add and delete a user. We will double check on that for sure. Thank you. I'm just checking the chat. Again, if you have questions please note to unmute your phone line, press pound six so you can ask a question. Do not be afraid. No question is stupid. Believe me, you would be amazed at the questions asked. It is a complicated system. We appreciate you offering your time to do this. I would like to point out a comment. Cynthia has reminded everybody that the SAMS card is very important. It has personal information tied to it. Protect it, keep it secure. I treat mine like a credit card. I leave it in my wallet. We have another question: Is there a deadline for enrollment? On the checklist, there is no enrollment deadline. Can you clarify that please? Do you know the exact dates of the enrollment time? Janet is not here today. I want to say that everyone is supposed to be enrolled by the end of October and that everyone has data in NHSN by November 25. That is why there is such a push to get this done. It does not happen in two minutes. I think you had a September deadline and NHSN pushed it out to October. We were recruiting for the CPI work through the end of August. All October data should be entered into the NHSN by November 25. If you're having problems, we do hope you reach out to your contact person. Does that help? Yes, thank you. Any more questions? We are having a bit of technical difficulty as far as being able to see the chat. The chat has disappeared from my screen. If you're putting a question in the chat, please press pound six and ask your question. There are no questions currently. Thank you, Florence.
Hello, this is Reggie. Since you cannot see the chat, I have responded that only administrators can edit or add the users. Users have the capability to add and edit some data and enter data. But only the administrator can do the overall adding and editing of users and looking at the data and entering data. It is the be-all end-all role. And there is only one administrator. So I hope that answers all the questions from the chat. Basically when an administrator is going to leave, they should go in and designate administrative rights on that page. I will go back to that page where you can see. If I was this person, if it was Maureen Marcela, I am the administrator. I added this new person. Now I'm leaving. I can check off administrator for this person. They will then have the rights as the administrator. They will then go in and deactivate me because I am leaving. Does that sound right? Correct. Can you hear me okay? Yes. We had a facility growth administrator that was leaving and notified us by email. We have to say to the person in the interim, you can use one of your SAMS users as a temporary administrator until you have a new person coming in to take that role. There are directions. I can send that along to you Maureen so that you can share it. Are they in the guide? It is in a different document that I will send to you. It went out of month ago. Okay. It is embedded in a very unusual place in this document. Okay. We will take that and send that out to all of you. I have another question and I think I know how to answer this one. Do I have to make a monthly reporting plan for each of my locations? Or does my one reporting plan apply to all? Your one reporting plan for the month applies to all. You only have to do a monthly reporting plan for the month for the facility. Remember, it picks it all up for you. When you click over here on the CDI, which we cannot see right now, you would click that. All you have to do is copy that. The CDI will go through for the whole facility of multi-locations that you have put into NHSN. We can save all these questions for next week because we will have open calling hours next week. I would like to thank you for this great discussion. It was terrific. I have just a few more announcements. When we close out of this webinar, the evaluation will automatically pop-up on your computer. If you could please fill that out. We would greatly appreciate it. It gives us an idea how successful our presentations are. If you do not have time to fill it out today, you will receive an email tomorrow morning with a link to the evaluation as well as the link to the event page on our website. Today's presentation will be posted on the website within a few days. The recording in transcript will be there. I am enclosing a last reminder.
Here is a slide with all our state contacts that are available to you on a one-on-one basis. Feel free to call them. If they are not available, feel free to call me. You can call me at 401-528-3223. I will be more than willing to help you walk through this process. We understand it is not an easy process. Thank you so much for attending today. We will talk to you next Wednesday at 11. Goodbye. [Event Concluded]