Complete 1 survey per state!

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* 1. Provide us with your state's programmatic contact information.

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* 2. Provide us with your state's technical point of contact.

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* 3. Provide the name of up to 2 clinical organizations you will be working with, as well as the EMR system they use and the approximate number of adult patients in their population. Indicate whether each EMR vendor has agreed or will agree to EMR modifications in writing.

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* 4. Provide the names of up to 2 community-based organizations (CBO) you will be working with. Indicate what evidence-based interventions the CBO offers related to diabetes prevention/management and hypertension/high cholesterol management. Indicate whether each CBO has the capacity to handle an influx of referrals.

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* 5. Have your participating clinical and community-based organizations established or agreed to establish a legal agreement defining their relationship?

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* 6. Have your participating clinical and community-based organizations agreed to share individual-level data with one another?

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* 7. Have your participating clinical and community-based organizations agreed to share aggregate-level data with the SHD / NACDD / CDC?

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* 8. What other questions do you have for the NACDD technical assistance team? We will post questions and answers on the NACDD website.

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