Rx for Prevention: Understanding CA Child Care and School Immunization Requirements and Medical Exemptions-Physician Evaluation Survey

For CME credits or Certificate of Attendance, please complete this survey to its entirety. Questions with an asterisk are mandatory. Thank you.

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* 1. What best describes your profession?
Health professionals who are not physicians should fill out this evaluation to obtain a certificate

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* 2. Do you work for the Los Angeles County Health Agency?

Yes-DPH

Yes-DHS

Yes-DMH

Yes-DPH

Yes-DHS

Yes-DMH

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* 3. Please provide the following information:
(this information will be kept confidential and will not be shared with third party groups).

First Name

Last Name

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* 4. Please provide the following information:
(this information will be kept confidential and will not be shared with third party groups).

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* 5. I participated in the enduring/archived CME material on:
(choose date of participation)

Date / Time

Date

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* 6. How well was each learning objective met:

	Fully Met	Somewhat Met	Not Met	N/A
1. Describe California’s immunization requirements for students entering pre-kindergarten (i.e., childcare), TK/K-12, and 7th grade.	1. Describe California’s immunization requirements for students entering pre-kindergarten (i.e., childcare), TK/K-12, and 7th grade. Fully Met	1. Describe California’s immunization requirements for students entering pre-kindergarten (i.e., childcare), TK/K-12, and 7th grade. Somewhat Met	1. Describe California’s immunization requirements for students entering pre-kindergarten (i.e., childcare), TK/K-12, and 7th grade. Not Met	1. Describe California’s immunization requirements for students entering pre-kindergarten (i.e., childcare), TK/K-12, and 7th grade. N/A
2. Identify the types of exemptions that are permitted under California’s pre-kindergarten and school immunization law.	2. Identify the types of exemptions that are permitted under California’s pre-kindergarten and school immunization law. Fully Met	2. Identify the types of exemptions that are permitted under California’s pre-kindergarten and school immunization law. Somewhat Met	2. Identify the types of exemptions that are permitted under California’s pre-kindergarten and school immunization law. Not Met	2. Identify the types of exemptions that are permitted under California’s pre-kindergarten and school immunization law. N/A
3. Identify defined contraindications and precautions to pediatric and adolescent vaccines required for pre-kindergarten and school attendance in the State of California.	3. Identify defined contraindications and precautions to pediatric and adolescent vaccines required for pre-kindergarten and school attendance in the State of California. Fully Met	3. Identify defined contraindications and precautions to pediatric and adolescent vaccines required for pre-kindergarten and school attendance in the State of California. Somewhat Met	3. Identify defined contraindications and precautions to pediatric and adolescent vaccines required for pre-kindergarten and school attendance in the State of California. Not Met	3. Identify defined contraindications and precautions to pediatric and adolescent vaccines required for pre-kindergarten and school attendance in the State of California. N/A
4. List the elements that are required to be documented for medical exemptions.	4. List the elements that are required to be documented for medical exemptions. Fully Met	4. List the elements that are required to be documented for medical exemptions. Somewhat Met	4. List the elements that are required to be documented for medical exemptions. Not Met	4. List the elements that are required to be documented for medical exemptions. N/A
5. Access resources, including screening questionnaires, forms, and patient education materials.	5. Access resources, including screening questionnaires, forms, and patient education materials. Fully Met	5. Access resources, including screening questionnaires, forms, and patient education materials. Somewhat Met	5. Access resources, including screening questionnaires, forms, and patient education materials. Not Met	5. Access resources, including screening questionnaires, forms, and patient education materials. N/A

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* 7. How likely are you to change your practice based on today’s activity?

Very Likely

Somewhat Likely

Not Likely

N/A-not related to my practice

Very Likely

Somewhat Likely

Not Likely

N/A-not related to my practice

If you answered VERY LIKELY or SOMEWHAT LIKELY above, please describe how you intend to change your practice based on the content of this activity

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* 8. Describe any barriers you need to overcome to implement these changes

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* 9. Was there any apparent commercial bias in the presentation? (Defined as content that promotes the proprietary interest of any specific entity that, produces, markets, re-sells, or distributes health care goods or services consumed by, or used on, patients.)

Yes

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* 1. What best describes your profession? Health professionals who are not physicians should fill out this evaluation to obtain a certificate

Question Title

* 2. Do you work for the Los Angeles County Health Agency?

Question Title

* 3. Please provide the following information: (this information will be kept confidential and will not be shared with third party groups).

Question Title

* 4. Please provide the following information: (this information will be kept confidential and will not be shared with third party groups).

Question Title

* 5. I participated in the enduring/archived CME material on:(choose date of participation)

Question Title

* 6. How well was each learning objective met:

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* 7. How likely are you to change your practice based on today’s activity?

Question Title

* 8. Describe any barriers you need to overcome to implement these changes

Question Title

* 9. Was there any apparent commercial bias in the presentation? (Defined as content that promotes the proprietary interest of any specific entity that, produces, markets, re-sells, or distributes health care goods or services consumed by, or used on, patients.)

* 1. What best describes your profession?
Health professionals who are not physicians should fill out this evaluation to obtain a certificate

* 3. Please provide the following information:
(this information will be kept confidential and will not be shared with third party groups).

* 4. Please provide the following information:
(this information will be kept confidential and will not be shared with third party groups).

* 5. I participated in the enduring/archived CME material on:
(choose date of participation)