The Office of Title V and Family Health at the Texas Department of State Health Services greatly appreciates you taking the time to complete this survey. Your responses will inform the selection of the Title V National Performance Measures for the next five years (fiscal year 2016-2020). Federal guidance allows states to select one Performance Measure in each of the six population domains, plus two additional Performance Measures from any population domain. Please take a moment to tell us about your role in Maternal and Child Health before completing the survey. Thank you for your feedback!

* 1. Please select the response that best describes your work setting:

* 2. Please select the response that best describes your area of focus:

* 3. Please enter your work zip code:

* 4. Please rank the following Performance Measures in the Maternal & Women's Health Domain:

* 5. Please rank the following Performance Measures in the Perinatal Health Domain:

* 6. Please rank the following Performance Measures in the Child Health domain:

* 7. Please rank the following Performance Measures in the Children with Special Health Care Needs domain:

* 8. Please rank the following Performance Measures in the Adolescent Health domain:

* 9. Please rank the following Performance Measures in the Crosscutting or Life Course domain:

* 10. Other than the highest ranked Performance Measure you selected from each of the 6 domains, please select TWO additional critical measures (Texas will be selecting a total of 8 Performance Measures):

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