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IDPH Zika Virus Survey for Clinical Providers
*
1.
What is your area of clinical expertise?
(Required.)
Physician - Family Practice
Physician - Internist
Physician - OB/GYN
Physician - Pediatrician
Physician - Other
Advance Practice Nurse - Certified Nurse Midwife
Advanced Practice Nurse - Other
Physician's Assistant
Nurse (RN, LPN)
Medical Assistant
Infectious Disease Practitioner
Other:
*
2.
In what setting is your
primary
clinical practice?
(Required.)
Hospital
Local Health Department
Federally-Qualified Health Center (FQHC)
Community Health Center
Private Practice
Other:
*
3.
In what zip code is your
primary
practice located?
(Required.)
100%
