Prenatal Risk Screening Form Training Post-Test

Thank you for taking the time to complete this brief post-test.

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* 1. Please complete the following information below

First Name *

Last Name

Job Title

Email Address *

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* 2. Which office do you work at?

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* 3. Healthy Start is a comprehensive program promoting optimal prenatal health and developmental outcomes for A and B in Florida.

Fathers, Babies

Pregnant Women, Babies

Pregnant Women, Fathers

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* 4. What are the goals of Healthy Start?

Reduce infant and maternal mortality

Decrease the number of low-birth-weight babies

Reduce sleep-related deaths

All of the above

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* 5. Who can be referred to Healthy Start?

Pregnant Women that score higher than 6 on risk factors

Any Pregnant Woman

Pregnant Women with additional unscored risk factors

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* 6. What does the perfect Prenatal Screening Form look like?(check ALL that apply)

All questions are answered completely

The patient signs and dates the screening form

The patient initials "Yes" to the release of specific information

Providers complete the "Providers Only" section in full

"Referred to Healthy Start" box is checks, and reason noted if less than 6

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* 7. What can Healthy Start do for you and your patients?

Provide Pregnancy Support and Education

Help to Quit Smoking

Family planning education

Parenting education and support

Home visiting programs

Car Seat Safety

Breastfeeding education and support

All of the above

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* 8. Your knowledge or skills have improved by completing this training

True

False

Prenatal Risk Screening Form Training Post-Test

Question Title

* 1. Please complete the following information below

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* 2. Which office do you work at?

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* 3. Healthy Start is a comprehensive program promoting optimal prenatal health and developmental outcomes for A and B in Florida.

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* 4. What are the goals of Healthy Start?

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* 5. Who can be referred to Healthy Start?

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* 6. What does the perfect Prenatal Screening Form look like?(check ALL that apply)

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* 7. What can Healthy Start do for you and your patients?

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* 8. Your knowledge or skills have improved by completing this training

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* 9. How would you rate your overall learning experience between 1-5?

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* 10. How can we improve the learning experience? (Optional)

Prenatal Risk Screening Form Training Post-Test

Question Title

* 1. Please complete the following information below

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* 2. Which office do you work at?

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* 3. Healthy Start is a comprehensive program promoting optimal prenatal health and developmental outcomes for ________A________ and ______B______ in Florida.

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* 4. What are the goals of Healthy Start?

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* 5. Who can be referred to Healthy Start?

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* 6. What does the perfect Prenatal Screening Form look like?(check ALL that apply)

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* 7. What can Healthy Start do for you and your patients?

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* 8. Your knowledge or skills have improved by completing this training

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* 9. How would you rate your overall learning experience between 1-5?

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* 10. How can we improve the learning experience? (Optional)

* 3. Healthy Start is a comprehensive program promoting optimal prenatal health and developmental outcomes for A and B in Florida.