DTaP Drop-Off Post-Survey Name * First and Last Name Credentials 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 OtherOther Please indicate the specific strategies you have implemented around increasing the rate of the fourth dose of the DTaP vaccination since taking part in the webinar. Please indicate which of the resources sent to you after the webinar you have used in your practice. (Check all the apply) DTaP Drop-Off Booklet Easy-to-Read Immunization Schedule DTaP Parent Handout DTaP Reminder Postcards OtherOther Please provide feedback on those resources. Would your practice be interested in joining a Quality Improvement program with the Ohio Chapter, American Academy of Pediatrics and potential receive MOC Part IV credit in the future? Yes No Maybe, I want more information If you are human, leave this field blank.
