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Last name
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Email
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Main Agency/Organization
Work zip code
What describes your profession?
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Administrator/Manager
Advanced Practice Nurse
Clerk/Administrative Assistant
Dentist/Dental Hygienist/Dental Technician
EMT/Paramedic
Epidemiologist
Health Educator
Health Facility Inspector
Health Informatics
Health Investigator
Infection Control Specialist
Journalist
Laboratory Director/Laboratory Specialist/Laboratory Technician
Medical Assistant/Health Aid
Occupational Therapist/Physical Therapist
Occupational Health and Safety Worker
Optometrist/Optician
Pharmacist/Pharmacy Technician/Aid
Physician
Physician Assistant
Podiatrist
Psychologist/Mental Health Provider
Registered Nurse
Student - Healthcare Professional
Veterinarian
Other
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What is your primary worksite
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College/University
Community Health Clinic/FQHC
Corrections
Emergency Management/Services/Prep
Health Plan/Insurance Company
Hospital - Non Emergency Department
Hospital - Emergency Department
Home Health
Indian Health
K-12 Schools
Laboratory
Medical Association/Society
Mental Health Facility
Nursing Association/Society
Occupational Health
Outpatient-Primary Care
Outpatient-Specialty Care
Pharmacy
Public Health
Skilled Nursing/Assisted Living/Rehab Facility
Urgent Care
Other
None
Physicians only: what is your primary specialty?
Allergy and Immunology
Anesthesiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine - General
Internal Medicine - Infectious disease (ID)
Internal Medicine - Non-ID Specialty
Neurology
Obstetrics/Gynecology
Ophthalmology
Otolaryngology
Pathology
Pediatrics
Preventive Medicine/Public Health
Physical Medicine/Rehabilitation Medicine
Psychiatry
Radiology
Surgery
Urology
Other Specialty
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