* 1. How many years have you been a licensed pharmacist?

* 2. Current practice site 

* 3. What board certification have you obtained? (check all that apply)

* 4. In your practice do you utilize theĀ Pharmacist Patient Care Process (PPCP):

* 5. Do you have a collaborative practice agreement protocol at your practice site?  If yes, then please complete the rest of the survey

* 6. Which tasks are you allowed to perform within the CPA regarding drug therapy? (Check all that apply)

* 7. Which disease states or areas of care are included in your protocol?

* 8. How many pharmacists in your practice areas are involved in the CPA?

* 9. How many providers are involved in the CPA?

* 10. Which option below best describes the institution that your CPA is in agreement with?

* 11. What types of barriers to implementation did you encounter with your CPA?

* 12. Please check all that apply:

* 13. May we contact you if we have further questions?  If so, please provide your preferred method of contact:

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