Submitted by wbruer on Mon, 02/02/2015 - 16:47 Middle East Respiratory Syndrome (MERS) Coronavirus: Epidemiological Challenges from its Discovery to Current Surveillance Last Name/First Name * Address * City * County (Parish or Borough) * State * Zip Code * Primary Phone # * Preferred Email Address * Employer Name * Are you employed by or work in the following? (select all that apply, if Other please specify below) * Rural Setting Federally-qualified Health Center (FQHC) - includes health care for the homeless; primary care public housing, migrant health center, school-based health center, rural health clinic Community-based Training Site - Area Health Education Center (AHEC) National Health Service Corps (NHSC) Site Hospital Nursing Home Community-based Organization/Non-profit Health Department, Local Health Department, State Academia - Education/College/University US Department of Health and Human Services Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration (HRSA) National Institutes of Health (NIH) Tribal Government Indian Health/Tribal Health Department Indian Health Service (IHS) Veteran's Administration (VA) Geriatric Education Center (GEC) Government, Other State Government, Other City Government, Other County Government, Other Federal Shortage Areas - Primary Medical Care, Mental Health and Dental Health Professional Shortage Areas (HPSA) Ambulatory Practice Site Designated by State Governor Public Housing Primary Care Other Medically Underserved Site such as emergency care facilities, state-owned facilities for indigent care, teaching hospitals and other teaching facilities with a Medicaid/Medicare patient population of 50% or more of the total patient population including public, non-profit, faith-based and charity facilities Other (specify) Other Health Profession Discipline (select one or if Other please specify below) * - Select -Allopathic MedicineChiropracticClinical Lab WorkerClinical PsychologyClinical Social WorkCommunity Health WorkerDental AssistantDental HygieneEMT - Paramedic/First ResponderGeneral DentistryHealth Education/BehaviorHealth Information Systems/Data AnalysisHealth Service/Hospital Nurse (LPN/LVNNurse MidwifeNurse Practitioner (NP)Nutrition - DieteticsOccupational TherapyOptometryOsteopathic General PracticePharmacyPhysical TherapyPhysician AssistantPodiatryPsychiatryPublic Health (General Studies)Registered NurseSubstance Abuse/Addictions CounselingVeterinary MedicineOther-specify below Other Do you work in a Primary Care Setting * Yes No Primary Care Setting -- a facility that provides integrated, accessible health services by clinicians who are ac-countable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Do you work in a Medically Underserved Community (MUC) setting? * Yes No Medically Underserved Community (MUC) Setting -- a geographic location or population of individuals that is eligible for designation by a state and/or the federal government as a health professions shortage area (HPSA); medically underserved area (MUA) and/or medically underserved population (MUP). These communities have limited access to primary health care services. The term MUC is an umbrella term that can be used to describe any location that meets one or more of the previously identified designations. Do your work in a Rural Setting? * Yes No Rural Setting -- a geographical area that is not part of a Metropolitan Statistical Area (MSA). A MSA is an area that contains a core urban area of at least 10,000 population. What code is in the image? * Enter the characters shown in the image.