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WIC Knowledge and Experience Pre/Post Video Survey
Demographics and Experience with WIC
Please complete this portion PRIOR TO watching the educational video.
The following questions will provide personal demographics and experience as it pertains to the Women Infant and Children Program (WIC).
OK
1.
What is your medical role?
Physician
PA/NP
Nurse
Other (please specify)
2.
What is your medical specialty?
Family Medicine
Obstetrics
Pediatrics
Other
3.
In what state are you presently stationed/located?
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
International Location
4.
What is your gender?
Man
Woman
Nonbinary
Prefer not to answer
5.
What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
6.
What is your race? (Check all that apply)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Prefer not to answer
7.
What is your military rank?
E1 - E4
E5 - E6
E7 - E9
O1 - O3
O4 - O6
O7 - O10
Civilian
Prefer not to answer
8.
Do you have any personal experience with WIC - Experience may include person and/or family utilization of WIC benefits or as a medical provider referring/recommending families to utilize WIC? (Check all that apply)
No, I do not have any personal experience with WIC.
Yes, I have experience both personally and professionally with WIC.
Yes, I have professional experience referring/recommending WIC to patients.
Yes, I have personal experience utilizing WIC benefits.
9.
Please elaborate on your experience with WIC.
Current Progress,
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