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* 1. Attendee Name

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* 2. Email

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* 3. Organization

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* 4. CME/CE beginning attendance code:

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* 5. CME/CE closing attendance code:

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* 6. If applicable, please identify license held:

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* 7. License number: 

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* 8. Upon completion of this activity, the audience will be able to:

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Define internalized, personally mediated, and institutional racism.
Identify ways that the racism and xenophobia impact the health and wellbeing of youth/immigrants in California
Recognize opportunities for addressing racism and xenophobia in medical settings  patients and providers.
Define ACEs (Adverse Childhood Events) and their impact on chronic disease.

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* 9. Facilitator was qualified to present this material.

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Marissa Raymond-Flesch, MD, MPH

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* 10. Course content was:

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Appropriate for intended audience.
Consistent with stated objectives.

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* 11. Overall, you were satisfied with:

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Your educational experience.
The method of instructional delivery.
I learned something useful from this program

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* 12. Was the information/material presented at this CME activity free from commercial bias?

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* 13. How did you hear about this CME activity?

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* 14. Please share topics of interest for future learning sessions. 

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* 15. Comments:

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