1. What are your 2nd Dose Immunization Rates after the implementation of an intervention:
Enter the % for at least one of the measures below (a, b, c and/or d).

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* a. 2nd Dose Meningococcal ACWY % (e.g. Menactra%)

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* b. 2nd Dose Meningococcal B % (e.g. Trumenba/Bexsero %)

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* c. 2nd Dose HPV (e.g. Gardasil /Gardasil 9%)

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* d. 2nd Dose Adult Hepatitis B % (Heplisav-B only)

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* 3. Describe the intervention you implemented in your practice to improve these immunization rates.

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* 4. Please share any strategies or pitfalls you came across that other CPP members may find helpful when implementing a similar strategy in their office.

To receive the CPP educational grant of $500, please provide the following information:

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* Practice Name

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* Practice Address

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* Contact Name

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* Contact Email Address

*Please note:  CPP will only use your contact information to issue the educational grant check.  CPP will not collect any patient specific information.  All immunization rates will be analyzed and reported as general trend data and will not be attributed to an individual practice.

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