As you may know, Washington State received funding to develop a statewide universal developmental screening system. Many physicians provided input into the initial planning in 2016. We now need to update with 2020 data, and respectfully request your response to the questions below. The information you provide will help us design and develop a system that satisfies the requirements of our funders while considering the needs of our partners and stakeholders.

Please respond to the following questions by COB March 13, 2020.

We appreciate your valuable input!

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* 1. What developmental screening tools do you use?

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* 2. Do you - or does your practice – have a Brookes Publishing license to use the Ages and Stages Questionnaire 3 (ASQ3)?

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* 3. What system or systems does your practice currently use to track developmental screenings? Please select all that apply:

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* 4. If your practice uses an electronic health record (EHR), who is your vendor?

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* 5. If your practice uses an EHR, does it include a module or other customized section to maintain client-level records for developmental screening and findings – e.g., test(s) used and score(s)?

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* 6. If your practice uses an EHR, are you satisfied with how you can track developmental screening with it?

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* 7. If your practice uses an EHR, what changes you would make to how your EHR tracks and supports the developmental screening you do with your clients? (optional)

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* 8. What would be an efficient way for you to enter developmental screening findings for your clients into a state data system?

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* 9. Name of Practice (optional)

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* 10. Name of Person Completing Survey (optional)

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