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 * ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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.