By June 8, please work with your team to complete this birth site-level survey for the period of January through March 2020.

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* 1. What is your health system name?

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* 2. Which hospital within your health system are you submitting data for?

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* 3. What is your name?

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* 4. Does your hospital currently have a process in place to provide ongoing OUD sensitivity training requirements for staff and providers?

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* 5. Does your hospital have standardized materials for educating women with OUD, regarding OUD and in pregnancy and the mother’s role in NAS newborn care (i.e. pediatric consult, patient education materials)?

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* 6. Does your site use a validated, self-report screening tool for substance use in pregnancy?

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* 7. Does your site provide opioid pharmacotherapy for pregnant women with OUD?

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* 8. Has your hospital developed referral relationships with any OUD treatment programs in your area/county?

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* 9. Has your site developed unique clinical pathways/order sets for pregnant women with OUD?

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* 10. Does your hospital provide immediate postpartum contraceptive counseling and services?

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* 11. If you answered yes for the above question, which contraceptive methods are provided in the immediate postpartum period? (Check all that apply)

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