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Pertussis Archived Webinar 2016- CME Certificate (Physicians Only)

CME Evaluation Form

Los Angeles County Department of Public Health
Pertussis in California - The New Normal: Recommendations and Resources for Health Care Providers

Instructions: Please complete this survey to its entirety. Questions with an asterisk are mandatory.

1. What is your full name as it should appear on the certificate? *This question is required.

2. I confirm that I am a physician and I viewed the archived webinar below in its entirety:
(For RNs and Others please click here to obtain a Certificate of Attendance) *This question is required.

3. On which date did you view the webinar?
*This question is required. Use this format - MM/DD/YYYY or click on the dropdown calendar.
This question requires a valid date format of MM/DD/YYYY.

calendar

4. Email address: *This question is required. This question requires a valid email address.

5. Overall, how well were the objectives of the Measles webinar met? *This question is required.

6. How likely are you to change your practice based on today’s activity? *This question is required.

7. If you answered very likely or somewhat likely, please describe how you intend to change your practice based on the content of this activity

8. Please check the box that indicates the degree to which you agree or disagree with the following statements: *This question is required.

Space Cell	Strongly Agree	Agree	Disagree	Strongly Disagree
A. The content of the webinar was relevant to me
B. The presenters were effective

9. Was there any apparent commercial bias in the presentation?
(Defined as content that promotes the proprietary interest of any specific entity that, produces, markets, re-sells, or distributes health care goods or services consumed by, or used on, patients.) *This question is required.

10. If you answered yes, there was commercial bias, please explain:

11. To assist us in planning future programs, please indicate topics you would like to have covered.

12. Do you have any other comments or suggestions?

13. Are you a member of the Los Angeles Health Alert Network (LAHAN)?

LAHAN is the Los Angeles County Department of Public Health’s provider alert system. LAHAN is used to communicate important public health information to healthcare professionals in Los Angeles County (LAC). LAHAN sends health alerts, advisories, and updates via email on topics such as disease outbreaks, emerging infectious diseases, immunizations, drug shortages and recalls. All LAC health care providers are encouraged to join LAHAN to improve communication during public health emergencies. LAHAN sends, on average, only 1-2 communications a month and the urgency and target audience are clearly marked.

14. Would you like to join LAHAN?

Note: Your subscription information will not be shared. If you have questions about signing up, email hanhelp@ph.lacounty.gov or call (213) 989-7236.

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