Self-Queriers Survey: Module 12
Number of questions: 3
Demographic Information
We are collecting demographic information so that we can describe the different kinds of organizations participating in this survey.
Q 12.1. What types of medical services does your organization provide (if applicable)?
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Q 12.2. What types of health care products does your organization produce or distribute (if applicable)?
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Q 12.3. In which jurisdiction is your organization located? (If your organization is located in more than one state, please list the state in which your organization's headquarters is located.)
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other (Please Specify) _______
Piping logic:
Survey will be directed to Module 13 next.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Microsoft User |
| File Modified | 0000-00-00 |
| File Created | 2021-04-12 |