CNE Evaluation – Immunization Reminder and Recall Interventions Name * First Last Name * Last Credentials * 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 * Which regional presentation did you attend? Columbus - 10/17/16 Cleveland - 11/2/16 Cincinnati - 11/9/16 OBJECTIVES: At the conclusion of this activity, are you able to: Define immunization reminders and recall * Yes No Present examples of immunization reminder and recall strategies * Yes No Discuss the benefits of and barriers to use of reminder/recall interventions for immunizations * Yes No SPEAKERS: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. Speaker demonstrated teaching effectiveness: Rebecca Brady, MD, FAAP * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Tamara Yates, RN * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Melanie Farkas * 1 2 3 4 5 OVERALL PRESENTATION: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. The presentation was well organized and logically sequenced. * 1 2 3 4 5 The material was not too difficult to understand. * 1 2 3 4 5 I gained new information. * 1 2 3 4 5 How would you rate your overall satisfaction with this activity? * Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Additional Comments: By signing or typing your name, you confirm your identity and attest to attending the entire educational activity. * Clear If you are human, leave this field blank.