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RX for Prevention- PrEP Evaluation for Physicians

CME Evaluation Form

Los Angeles County Department of Public Health
Rx for Prevention-PrEP

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 complete the activity? *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

5. Email address: *This question is required. This question requires a valid email address.

6. 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. Conduct a Sexual History
2. Describe the selection of candidates for PrEP
3. Discuss the management of the patient on PrEP
4. Discuss PrEP therapy and side effects
5. Discuss patient resources for PrEP education

7. How likely are you to change your practice based on this activity? *This question is required.

8. If you answered very likely or somewhat likely, please describe how you intend to change your practice based on the content of this activity

9. 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.

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

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

12. Do you have any other comments or suggestions?

13.

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

14. 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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