2016 CHDP Provider Survey Question Title 1. Clinic Name Question Title 2. Please check Physician Nurse Practitioner Physician Assistant Nurse Medical Assistant Office Staff Question Title 3. Approximately, how often are you in contact with CHDP Staff? Once or twice a week Once or twice a month 0-5 times a year More than 5 times a year Other (please specify) Question Title 4. Please select any of the following CHDP local program activities you have received (check all that apply) New Provider/Office Staff orientation to CHDP Program Staff inservice or program update (noontime inservice or other event) Billing Support Other administrative assistance/office forms Limited/Full Facility or Medical Record review Client care coordination/follow up Outreach/education activities Assistance finding community resources Question Title 5. CHDP staff acknowledge me, take time to understand my needs, and speak in a respectfultone. Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree N/A Question Title 6. CHDP staff is knowledgeable about their work and help me solve problems. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree N/A Question Title 7. CHDP staff respond to my questions in a timely manner. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree N/A Question Title 8. Have you attended at least one of our CHDP monthly noontime in services ( e.g. Vision screening, Lead in service, School Updates) A. Yes B. No C. Not aware Question Title 9. Have you visited the new Ventura County CHDP website (www.vcchdp.org)? Yes No Question Title 10. If you have visited the CHDP website, were you able to find the information you needed? Yes No N/A Question Title 11. Please select the Children's Medical Services Programs you are familiar with. CHDP - Child Health and Disability Prevention Program CLPPP - Childhood Lead Poisoning Prevention Program CHDP Children's Oral Health/Fluoride Varnish Program CHDP Foster Care (Health Care Program for Children in Foster Care - HCPCFC) CCS - California Children's Services CCS MTP - Medical Therapy Program VC-PACT Ventura County Pact Question Title 12. How could we serve you better? Please comment. Question Title 13. If you would like the results of this survey to be shared with you, please provide: Name (optional) Email address: Done