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* 1. Name of Practice (if you have more than one site, please indicate name and email of one doctor at each site to complete survey under Question #3 )

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* 2. Medical Director

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* 3. PCP and email of PCP seeing children (1 name at each site)

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* 4. Best phone number for parents to call to reach someone at the practice (please respond only for main site at which you work.  We will invite the colleagues you indicated in Question #3 to respond for their own sites).

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* 5. What is the best way for a parent/guardian to get help with a sick visit at your practice? (Select all that apply and fill answers in the comment box)

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* 6. What is the best way for a parent/guardian to get help with a Well Visit for < 24 months old? (Select all that apply and fill answers in the comment box)

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* 7. What is the best way for a parent/guardian to get help with Well Visit for >24 months old? (Select all that apply and fill answers in the comment box)

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* 8. What is the best way for a parent/guardian to get help with Refills on medications, diapers, other DME needs? (Select all that apply and fill answers in the comment box)

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* 9. Do you expect changes in these protocols within the next few weeks?

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