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* 1. Clinic Name and VFC PIN

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* 2. From March 1 to May 1, did your office:

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* 3. If your practice is Temporarily or Permanently Closed:  Have your pediatric/adolescent patients been referred to another medical home?

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* 4. What is the current status of your practice?

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* 5. In the next 30 days, what do you anticipate the operational status of your practice to be (please consult with practice administration if necessary):

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* 6. When will your office open for full-time hours to provide vaccines?

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* 7. For practices that are open and providing routine services, which age groups is the practice currently offering immunizations (please check all that apply):

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* 8. How does your practice do recall/reminders for pediatric/adolescent patients who are due/overdue for vaccines?  Please check all that apply.

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* 9. Due to COVID-19 related reasons, some practices are having to find new non-traditional ways to provide vaccines to patients.  Will your practice be using any of the following non-traditional ways to ensure that your patients are provided with vaccinations?  Please choose all that apply:

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* 10. Would you be opposed to ADPH Immunization Division sending out a state-wide postcard to all children, ages 0-18 yrs, who are overdue for vaccine(s)?

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