Johnson & Johnson / Ethicon
Medical Mission Feedback Report

Partner Information

7% of survey complete.

MAP International is diligent in following where our medicines/supplies are distributed and how people are being treated and healed. We require details about your recent mission to enable us to serve you better and share about our partnership with others. Please take a few minutes to tell us about your recent order and mission experience.

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* Please provide your name and contact information:

First Name

Last Name

Suffix

Address 1

Address 2

City

State

ZIP

Phone

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* Order Number(s) for this trip and report - if known:

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* When did your team leave the US on this mission trip?

Departure Date

Date

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* When did your team return from this mission trip?

Return Date

Date

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* Please identify the number of the following types of US health professionals on this mission team.

Physician (MD, DO)

Mid-level provider (PA, NP, Midwife)

Nurse

Pharmacist

Other (EMT, Public Health, Med Tech, etc.)

Non-medical team members