|
Questions marked with an asterisk (*) are mandatory.
Clinicians, your input is requested to help us improve future versions of the Diabetes and Cardiovascular Disease Provider Reference Guide. Please take a moment to complete this evaluation
to improve the effectiveness and support this Reference Guide provides you and your practice.
| |
1
|
* How would you rate your overall satisfaction with the content of the Reference Guide?
| Very Satisfied | Satisfied | Neutral | Dissatisfied | Very Dissatisfied |
1
|
2
|
3
|
4
|
5
|
| |
2
|
* The content within each section is useful and relevant?
1
Very Satisfied | 2
Satisfied | 3
Neutral | 4
Dissatisfied | 5
Very Dissatisfied |
| Diabetes as a Cardiovascular Disease Overview |
|
|
|
|
|
| Screening and Diagnoses of Type 2 Diabetes |
|
|
|
|
|
| Clinical Management of Diabetes |
|
|
|
|
|
| Management of Diabetes-Related Cardiovascular Disease |
|
|
|
|
|
| Preventing and Managing Complications |
|
|
|
|
|
| Self Management Resources and Patient Education |
|
|
|
|
|
| Clinical Resources for Health Care Providers |
|
|
|
|
|
| |
3
|
Please provide any recommendations to strengthen future versions to the Reference Guide.
| |
Your answers to the following questions will help us assess whether we are addressing the needs of the various types of clinicians and practices that care for patients
with diabetes. It will also help ensure a continued focus on reducing health disparities and access to care issues.
| |
4
|
* What type of training do you have?
| MD/DO |
| PA |
| NP |
| Other, please specify |
|
| |
5
|
* State your practice located in?
| |
6
|
* Practice characteristics (check all that apply)
| Urban |
| Rural |
| Suburban |
| Solo/Small Group Practice (1-4) |
| Medium Group Practice (5-150) |
| Large Group Practice (151-1000) |
| Very Large Group Practice (>1000) |
| |
7
|
| Private Practice |
| Public Health Clinic |
| Community Clinic/Community Health Center |
| Other, please specify |
|
| |
8
|
* Your estimated percent of your patients diagnosed with Type 2 Diabetes? (Please enter only whole numbers between 1% to 100%)
| |
9
|
Race/Ethnicity (Optional)
| African American/Black |
| Alaskan Native/Native American |
| Asian |
| Hispanic/Latino |
| Native Hawaiian or Other Pacific Islander |
| White |
| |
10
|
* Would like to receive updates, tools and resources developed by CMA Foundation's Advancing Practice Excellence in Diabetes Program?
| |
|
|