MenB On Site Kickoff CME Evaluation Name (First, Last, and Credentials) * Please type your name (and credentials) as you would like it to appear on your CME Certificate. Practice/Organization * Email Address * Phone Number * Address * Address 2 City * State * ------AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Specialty * Primary Care Medical Subspecialty Surgeon Hospitalist Urgent Care How can the Ohio AAP Assist in meeting your education needs? * At the conclusion of this activity, are you able to: Discuss Neisseria meningitidis (meningococcus) and its associated diseases * Yes No Review meningococcal ACWY vaccines * Yes No Review meningococcal B vaccines * Yes No On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. The content matched my current or potential scope of practice. * 1 2 3 4 5 The speaker was knowledgeable and able to effectively teach the content. * 1 2 3 4 5 As a result of participating in this learning activity, do you intend to make changes in your practice? * Yes No If yes to the previous question: Please describe what you will do differently in practice [performance]. How will you accomplish this change in practice [competence]? How would you rate your overall satisfaction with this activity? * Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied By signing or typing your name, you confirm your identity and agree to the conditions and disclosures of this survey. * Clear Today's Date If you are human, leave this field blank.
