Section 1: Practice Demographics

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1. Practice Location

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2. Number of pediatric providers in your practice

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3. Approximate percentage of patients with Medicaid

Section 2: Vaccine Policies

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4. Which vaccine schedule does your practice formally follow?

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5. Does your practice have a formal written vaccine policy?

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6. Does your practice accept non-vaccinating patients?

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7. How can patients find your vaccine policy? (Select all that apply)

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8. Which statement best describes your policy?

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9. If you indicated exceptions are allowed, what are these exceptions?

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10. How does your practice respond to families requesting a non-standard or delayed schedule?

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11. How does your practice respond to partial vaccine refusal of daycare/school required vaccines (e.g., refusing specific vaccines)?

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12. At what point, if any, does daycare/school required vaccine refusal lead to dismissal from the practice?

Section 4: Scenario based questions
Scenario 1:

A 2-month-old infant presents for a well visit. Parents decline all vaccines but request continued care.

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13. How would your practice respond?

Scenario 2:

Parents agree to all vaccines except MMR due to safety concerns.

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14. Your practice would:

Scenario 3:

A 2 month-old infant presents for a well visit. Parents decline Hepatitis B but accept all other vaccines and request continued care.

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15. How would your practice respond?

Section 5: Vaccine Policy Impact and Resources

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16. What factors most influence your vaccine policy? (Select up to 4)

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17. Has enforcing a vaccine policy impacted your practice negatively in any of the following ways? (select all that apply)

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18. Optional comments or best practices regarding vaccine policies you wish to share:

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19. What resources would be most helpful in promoting the AAP vaccine policy in your office?

Section 6: Measles

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20. At what age does your practice routinely administer the first dose of MMR?

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21. Under what circumstances does your practice administer MMR prior to 12 months of age? (Select all that apply)

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22. At what age does your practice routinely administer the second dose of MMR?

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23. Is your office offering an accelerated MMR schedules due to outbreaks?

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24. Has your practice made any changes to its vaccine policies in response to the current measles outbreak?

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25. If yes, which changes have been implemented? (Select all that apply)

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26. Have families expressed increased concern or interest in MMR vaccination due to the outbreak?

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27. Has your practice implemented workflow changes related to measles prevention or MMR vaccination?

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28. If yes, which workflow changes have been made? (Select all that apply)

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29. Has your practice adjusted front desk or phone triage protocols related to measles symptoms?

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30. How has your practice communicated measles-related information to families? (Select all that apply)

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31. What resources with regards to measles would be most helpful to your practice?

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