Elders, Knowledge Holders and Culture Keepers ECHO (Wellness Wheel)

To submit a case, fill out the form below.

Prefer to complete it in your own time? Download this form and email it to the contact listed on the form.

If you have any questions about this case form, please contact kdean@npaihb.org or echo@npaihb.org.

Presenter Name
(also indicate if none)
Please enter a number from 0 to 120.
(also indicate if none)
Check if follow up to a previously presented case
Psychosocial support, family resources, network of care
Indigenous, cultural, spiritual, religious practices
Physical health, medications
Mental and emotional health, substance use

By submitting this form, you have acknowledged that Project ECHO case consultations do not create or otherwise establish a provider-patient relationship between an ECHO clinician and any patient whose case is being presented in a teleECHO session. Always use Patient ID# when presenting a patient in clinic. Sharing patient name, initials or other identifying information violates HIPAA privacy laws.