Email address that all surveys for this record should be delivered to
Today M-D-Y
Please name the population health improvement project or program you are working on.
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Which of the following Duke Health missions does your project align with?
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Activity Type(s)
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Please specify other activity type
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Senior leader first name
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Senior leader last name
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Senior leader credentials (e.g. MD, PhD, MA, MS, etc.)
Senior leader phone number
Senior leader email
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Please enter the Duke affiliation of the senior leader for this population health project.
Is there another senior leader of this project?
Yes No
Senior leader credentials (e.g. MD, PhD, MA, MS, etc.)
Senior leader phone number
Please enter the Duke affiliation of the senior leader for this population health project.
Is the senior leader the contact person for this project?
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Yes No
First name
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Last name
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Email
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You entered the name of a person to contact but did not provide an email address or phone number.
Please provide an email address or phone number for the contact person.
Please mark all Duke schools, centers, and institutes affiliated with this project.
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Please enter the name of your center, institute, or department affiliation within the Duke Divinity School
Please enter the name of your center, institute, or department affiliation within the Duke Law School
Please enter the name of your center, institute, or department affiliation within the Fuqua School of Business
Please enter the name of your center, institute, or department affiliation within the Nicholas School of the Environment
Please enter the name of your center, institute, or department affiliation within the Pratt School of Engineering
Please enter the name of your center, institute, or department affiliation within the Sanford School of Public Policy
Please enter the name of your center, institute, or department affiliation within the Duke School of Medicine
Please enter the name of your center, institute, or department affiliation within the Duke School of Nursing
Please enter the name of your center, institute, or department affiliation within the Trinity College of Arts & Sciences
Please specify other Duke affiliation
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Approximately what date did or will this project or program start?
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Today M-D-Y
Approximately what date did or will this project or program end?
If the project is ongoing, meaning it has no end date, please specify below.
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Today M-D-Y
This project is ongoing or has no end date.
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Yes No
How frequently is the project performed?
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Daily
Weekly
Monthly
Quarterly
Biannually (twice a year)
Annually
Not Applicable
Please provide us with a 150 word summary of the population health improvement project or program.
Here are things to consider for creating your summary:
• How does your program/project aim to improve population health?
• How does your program partner with Duke and community?
• What are your actual or anticipated population health outcomes?
• Describe your plans to extend or expand this program or project.
• What is the innovative nature of your program/project?
• What are the goals and objectives of your efforts?
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If you have a website that describes your project or program, please enter it.
Do you allow others to come and speak to your group to gather input and suggestions on their community and population health improvement efforts?
Yes No
Please mark all of the types of Duke partners for this project.
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Please specify other Duke partner type
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What health factors does this project aim/seek to address? Mark all that apply.
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Please specify other health factor
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What is the target population(s) of your project? Mark all that apply.
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Please specify other target population
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Where is the target impact area of this project? Mark all that apply.
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Please name the specific target area of impact for this project.
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Please mark all Durham community partners involved with your project.
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Please provide the name of any other Durham community partners involved with your population health effort.
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What are the community sectors you partner with?
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Please specify other community sector
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Does your project target any specific neighborhood?
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Yes No
Which neighborhood?
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Does your project target any specific zip code(s)?
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Yes No
Which zip code(s)?
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Indicate the sources of funding that supports your population health improvement project or program. Mark all that apply.
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Please specify other funding source
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Do you know of any other faculty or staff at Duke that are leading Population Health Improvement efforts in Durham?
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Yes No
Please enter the name(s) and email address(es) of the faculty or staff members that you know are working on Population Health Improvement efforts in Durham.
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After submitting this survey, you will be provided a link to a PDF copy of your survey responses. If, after reviewing your responses, you would like to change your answers to this survey, please contact Niasha Fray at niasha.fray@duke.edu.
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