12 Organizations - Demographics

12 Organizations - Demographics.docx

Survey of Eligible Users of the National Practitioner Databank

12 Organizations - Demographics

OMB: 0915-0366

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OMB Number: 0915-0366; Expiration date: XX/XX/202X


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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMicrosoft User
File Modified0000-00-00
File Created2021-04-12

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