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  1. Surveys
  2. 2016
  3. January
  4. C
  5. Community Pediatrician Practices
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Exit Survey
 
 
Hello!
My name is Kasey Jackson and I am a second year pediatric resident at Children’s Hospital of The King’s Daughters in Norfolk, VA doing a project related to findings on the Newborn Screen and follow up of specific items as they relate to your patients in the community.

Please take a moment to fill out this short anonymous survey to the best of your ability. It will take approximately 5 minutes to complete the questionnaire. Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact me by email at [email protected].
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Thank you very much for your time and support. If you agree to the terms, click I agree then proceed to start with the survey now by clicking on the Continue button below.
 
 
 
 
* What is the estimated ethnic make-up of your patient population? (please have sum be 100%)
Caucasian
African American
Hispanic
Asian
Other
0
Values must add up to 100
 
 
 
If you selected "other" in the question above, please elaborate:
   
 
 
 
* How would you describe your practice? (please select all that apply)
 
Academic
 
Hospital-affiliated
 
Military
 
Rural
 
Urban
 
Surburban
 
Private – solo practice
 
Private – group practice

 
 
 
* What is the estimated Medicaid population of your practice?
 
0-10%
 
10-50%
 
50-75%
 
>75%
 
 
 
If a newborn screen is positive for Sickle Cell Disease SS what is your current personal or practice protocol?(please check all that apply)
 
Refer to Hematology
 
Repeat NBS
 
Start on Folic Acid/PCN VK
 
Refer to Genetics
 
None of the above
 
Other