American Academy of Pediatrics - New York District II
Member Interest Survey

Name:
First:  MI:     Last:         Degree:  

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Preference for receiving information:
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Special instructions for information delivery (e.g. - call before faxing, etc.):



I am interested in the following issues:
(check all that apply)

I.  Ensuring Access to Health Care

A.   Improving Medicaid and Child Health Plus (Check this box for A1-7)

  1. Increase CHP vaccine reimbursement
  2. Implement Medicaid eligibility expansion
  3. Implement Medicaid presumptive eligibility
  4. Market Medicaid and CHP and children's health insurance
  5. Implement facilitated enrollment
  6. Eliminate Medicaid face-to-face interview
  7. Simplify recertification

B.   Expanding Prenatal Care Assistance Program (PCAP) eligibility

C.   Physician capacity

  1. Fee-for-service reimbursement
  2. Medicaid managed care reimbursement
  3. Collective negotiation

D.   Implementation of newborn hearing screening

E.   Expand home visiting program

II.  Child Care

A.   Ensuring quality, available and affordable child care

B.   Universal Pre-Kindergarten: Ensuring consistent and stable funding to allow Universal Pre-K to become a reality

III.  Gun Violence

Protecting children, young people and communities from gun violence.

IV.  Other - Identify other issues that you would like the AAP to address:

Check all activities you would like to participate in related to the issue areas of interest that you identified:
(AAP will provide materials to support these activities)

  1. Receive informational updates
  2. Communicate with your elected officials on specific issues
    • Write letters
    • Send e-mails
    • Send faxes
  3. Submit an opinion piece to your local paper
  4. Attend an editorial board meeting at your local paper
  5. Represent the AAP at a hearing, forum or press conference
  6. Meet with your state elected officials in Albany
  7. Meet with your state elected officials in their District office

Your Elected Officials

Please indicate if you have any professional or personal relationship with your elected official(s), including their children, grandchildren, etc.  You can find out who your representatives are by calling your county board of elections or by visiting the NYS Board of Elections website.

My New York State Senator is:  

          Relationship, if any:  

My New York State Assemblyman is:  

          Relationship, if any:  

My Congressional Representative is:  

          Relationship, if any:  

Check here if you do not know who your representatives are and would like us to contact you with the information.

Please indicate if you have any professional or personal relationship with elected officials (including their children) OTHER than those listed above:

Click to submit:  

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