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Coordinated by the Kidney Community Emergency Response (KCER) Program

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* 1. Please enter the state or territory where your clinic provides treatment:

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* 2. Please select your discipline:

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* 3. Do you provide emergency preparedness resources in languages other than English?

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* 4. How do you educate patients in your clinic about emergency preparedness?

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* 5. In the last year, how often have you educated your patients on emergency preparedness?

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* 6. In the last year, how often has your clinic conducted or participated in a disaster drill or exercise?

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* 7. My patients have a good understanding of where to go, what to do, and whom to contact in an emergency.

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* 8. My patients have a good understanding of the 3-day emergency renal diet.

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* 9. Do you educate your patients about medications that can help reduce their potassium level, such as Kayexalate?

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* 10. Does your clinic provide a "grab and go" packet for each patient?

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* 11. If yes, what does it contain? Check all that apply:

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* 12. Please provide any additional comments you would like to share, including any specific challenges or best practices related to emergency preparedness.

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