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RX for Prevention- Zika Evaluation for PHYSICIANS

CME Evaluation Form

Los Angeles County Department of Public Health

Preventing Zika Virus Infection and its Consequences: Update and Guidance for Clinicians

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 participated in the activity/ read the article below: *This question is required.

3. On which date did you participate?
*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. How well were these objectives met?
As a result of this session, I am now able to: *This question is required.

Space Cell	Fully Met	Somewhat Met	Not Met
1. Discuss the importance of providing culturally sensitive counseling of “bi-national” pregnant women to modify their travel plans in order to prevent the acquisition of Zika.
2. Indicate the defined time periods that couples wanting to conceive should abstain from sex or use condoms after either partner travels to an affected area.
3. Summarize the recommendations to reduce the risk of mosquito bites.
4. List the current indications for testing for Zika infection.
5. Discuss strategies to reduce the community risk of a local Zika outbreak.

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. 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.

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

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

11. Do you have any other comments or suggestions?

12.

Are you a member of the Los Angeles Health Alert Network (LAHAN), the Department of Public Health’s (DPH) provider alert system? (optional)

13. Would you like us to sign you up for LAHAN?

Note: DPH uses LAHAN to email priority communications on issues such as local outbreaks, emerging health issues, and drug shortages. There are, on average, 1-2 communications a month and the urgency and target audience are clearly marked. DPH will not share your contact information and it is simple to unsubscribe. To learn more, ask questions, or view previous communications visit publichealth.lacounty.gov/lahan

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