2015 ACDIS Conference-Pediatric CDI luncheon Question Title * 1. Does your CDI program currently review pediatric medical records? Yes No Don't know Other (please specify) Question Title * 2. If your CDI program reviews pediatric medical records, please describe your program (check all that apply): We are a children's hospital We are an academic children's hospital We have a PICU/NICU unit within our facility and a CDI staff member focused on these records We have a neo-natal unit at our facility and currently review these records We review records for our related pediatric physician practices We do not currently review children's records but are looking to expand into this area Other (please specify) Question Title * 3. Are you attending the ACDIS 2015 National Conference in San Antonio? Yes No Don't know Question Title * 4. Are you interested in participating in our pediatric CDI roundtable discussion on Tuesday, May 19, from 12-1:30 p.m. (during Day 1 of the 2015 ACDIS Conference)? *Note: Seating is limited and invitations will be based on those working with pediatric CDI populations currently. Yes No Question Title * 5. If you are interested in joining the pediatric CDI roundtable please fill in your demographic information. Name: * Company: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: * Done