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* 1. Please enter your first and last name as you would like it to appear on your CME certificate.

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* 2. Please select your title

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* 3. What is your specialty?

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* 4. E-mail address for receiving certificate

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* 5. Did you perceive any commercial bias associated with this activity?

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* 6. If you answered yes to the previous question, please describe perceived bias.

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* 7. What new strategies will you implement as a result of your participation in this activity?  (Please check all that apply.)

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* 8. What is the most chronic childhood disease?

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* 9. How many children covered by Medicaid have received preventive oral care for which they are eligible?

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* 10. What barriers do you perceive to implementing new strategies or treatment plans?

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* 11. What other educational content can KMA provide to support your professional development?

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