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1. What is your current role(s) within the provider agency?
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2. Please select the catetory that best represents the current number of hours per month that you are employed by the provider agency.
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3. Please select the category that best represents the length of time that you have been employed with the current provider agency.
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4. Please select the category that best represents the total number of individuals that you currently provide monthly Community RN services for.
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5. Do you currrently have additional authorized nursing hours for services above and beyond the allotted 1.25 per month per consumer?
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6. Are you currently able to observe Level I Med Aide certified staff administer medications to consumers? If so, on average how frequently?
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If your answer is Yes, please click on the "Yes" radio button then proceed to type in the additional information requested in the box below (please do so without clicking on the radio button in front of the box).
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7. Are you currently certified as a Level I Medication Aide Instructor?
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8. Please select the category that best represents how you currently communicate identified needs/concerns to the provider agency.
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9. With whom do you generally communicate identifed needs and concerns?
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(Select one)
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10. Do you participate in the agency meetings to discuss consumer issues? If so, how frequently?
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If your answer is Yes, please click on the "Yes" radio button then proceed to type in the additional information requested in the box below (please do so without clicking on the radio button in front of the box).
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11. Do you participate in the consumer's annual planning process?
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12. Do you communicate directly with the consumer's practitioners regarding medical/health issues? If not, do you know who functions in this role?
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If your answer is No, please click on the "No" radio button then proceed to type in the additional information requested in the box below (please do so without clicking on the radio button in front of the box).
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13. What areas do you feel additional training and/or information is needed for Community RN's?
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14. What areas do you feel additional training is needed for direct care staff?
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15. Please feel free to share any additional comments you may have.
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16. Please check the applicable box/es to identify the region/s in which you currently work.
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