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1. What type of organization do you represent (check all that apply):
*
Local Health Department
State or Local Coalition
Community Health Organization
Hospital, Clinic, Practice, or Medical Facility
Academic Institution (College, University)
Elementary/Secondary School
Medical/Health Professional Association
Faith Based Organization
Person with Asthma
OTHER
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2. Name of organization:
*
If you can see this field, please leave it blank.
3. What is your position in the organization (check all that apply): *
Physician
Nurse
Health Educator
Epidemiologist
Researcher
Faculty
Community Leader
Government Official
Legislator
Administrator
OTHER
4. How will you use this report (check all that apply): *
Grant-writing
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Presentations
OTHER
5. For each statement below, please select the choice that best reflects your opinion: *
a. This report is clear and easy to understand.
b. This report is well-organized.
c. This report has improved my understanding of Asthma in North Carolina.
d. This report will be useful to me in my work.
6. Please rate the usefulness of each section: *
a. The Executive Summary was:
b. The Introduction was:
c. The Asthma Prevalence section was:
d. The Asthma Management and Quality of Life section was:
e. The Health Care Utilization section was:
f. The Mortality section was:
g. The Healthy People 2010 section was:
h. The Discussion, References, and Technical Notes were:
i. The Appendices were:
7. Please list any other content areas that you would like to see in future editions:
8. Please list any organizations (name, phone #) you feel would benefit from this report:
9. Other comments/questions/suggestions:
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