EXP-2 | HRSA EHBs

EXP-2 - Selecting Training Program and Site Name

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Type of Training Program	Site Name
(1)	(2) Block 1

Figure 1. EXP-2 - Selecting Training Program and Site Name

Type of Training Program: Select a training program by clicking on the drop-down menu under "Type of Training Program" and choosing one of the available options.Site Name:

Select a site name by clicking on the drop-down menu under Block 1 and choosing one of the available options. Repeat this process until all used Training Program/Site combinations used in EXP-2 are present.

Note
The EXP-2 form will initially appear blank.

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Select Profession of Individuals Trained	Select Discipline/Specialty of Individuals Trained
(3)	(3a)

Figure 2. EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

Select Profession of Individuals Trained: Select the individual’s profession by clicking on the drop-down menu in Column 3 and selecting one of the available options.

Allied Health
Allied Health - Student
Behavioral Health
Behavioral Health - Student
Dentistry
Dentistry - Student
Medicine
Medicine - Student
Nursing
Nursing - Student
Other
Other - Student
Paraprofessional
Paraprofessional - Student
Physician Assistant
Physician Assistant - Student
Public Health
Public Health - Student

Select Discipline/Specialty of Individuals Trained: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 3a and choosing from one of the available options. Please note that you must select a discipline/specialty that is associated with the profession you selected in Column 26c. The disciplines/specialties are organized by profession in the drop-down; please scroll to find the correct option.

ALLIED HEALTH OPTIONS (please select)
Audiology
Certified Nursing Assistant
Community Health Worker
Dental Assistant
Dental Hygiene
Dental Hygiene/Public Health
Dental Therapy
Dialysis Technology/Technician
EMT/Paramedic
Home Health Aide
Medical Assistant
Midwife (non-nurse)
Nurse Assistant/Patient Care Associate
Nutritionist/Dietician
Occupational Therapy
Optometry
Pharmacy
Pharmacy Aide/Technician
Phlebotomy Technician
Physical Therapy
Physical Therapy Assistant
Radiological Technician
Rehabilitation Therapy
Respiratory Therapy
Speech Pathology/Therapy
BEHAVIORAL HEALTH OPTIONS (please select)
Addictions Counseling
Clinical Mental Health Counseling
Clinical Psychology
Clinical Social Work
Counseling Psychology
Marriage and Family Therapy
Pastoral/Spiritual Care
Professional Counselor
School Counseling
School Psychology
School Social Work
DENTISTRY OPTIONS (please select)
Advanced General Dentistry
Dental Anesthesiology
Dental Public Health
Endodontics
General Dentistry
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Oral and Maxillofacial Surgery
Oral Medicine
Orofacial Pain
Orthodontics and Dentofacial Orthopedics
Pediatric
Periodontics
Prosthodontics
DENTAL SCHOOL OPTIONS (please select)
Dental School
Dental School/Public Health
MEDICAL OPTIONS (please select)
Aerospace Medicine
Allergy and Immunology
Anesthesiology
Colon and Rectal Surgery
Dermatology
Emergency Medicine
Family Medicine
General Surgery
Geriatric Medicine
Geriatric Psychiatry
Integrative Medicine
Internal Medicine
Internal Medicine/Family Medicine
Internal Medicine/Pediatrics
Medical Genetics and Genomics
Medical Oncology
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology - Head and Neck Surgery
Palliative Care
Pathology - Anatomic and Clinical
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Plastic Surgery - Integrated
Preventive Medicine/Aerospace Medicine
Preventive Medicine/Family Medicine
Preventive Medicine/Internal Medicine
Preventive Medicine/Occupational Medicine
Preventive Medicine/Pediatrics
Preventive Medicine/Public Health
Psychiatry
Public Health and General Preventive Medicine
Radiation Oncology
Radiology - Diagnostic
Thoracic Surgery - Independent
Thoracic Surgery - Integrated
Urology
Vascular Surgery - Integrated
MEDICAL SCHOOL OPTION (please select)
Medical School
NURSING OPTIONS (please select)
Advanced Practice Nursing
Aggregate/Systems/Organizational
Alternative/Complementary
Clinical Nurse Leader (CNL)
Clinical Nurse Specialist (CNS)
Community Health Nursing
Forensics
Licensed Practical/Vocational Nurse (LPN/LVN)
Nurse Administrator
Nurse Anesthetist
Nurse Educator
Nurse Midwife
Nurse Practitioner (NP)
Nursing Informatics
Public Health Nurse
Registered Nurse (RN)
Researcher/Scientist
OTHER OPTIONS (please select)
Chiropractic
Direct Service Worker
Doula
Exercise Physiology
Facility Administrator
Firefighter
Health Informatics/Information Technology
Law Enforcement
Lay/Family Caregiver
Medical Laboratory Sciences
Office/Support Staff
Podiatry
Veterinary Medicine
Primary School (grades K-8)
Secondary School (grades 9-12)
Post-high School/Pre-college
Undergraduate School
Post-baccaluareate Premedical
PARAPROFESSIONAL OPTIONS (please select)
Behavioral Health Technician/Aide
Mental Health Worker
Outreach Worker
Peer Paraprofessional
Promotora
Recovery Coach
Social Services Aide
Substance Use/Addictions Worker
Youth Worker
Discipline/Specialty Not Listed
PHYSICIAN ASSISTANT OPTION (please select)
Physician Assistant
PUBLIC HEALTH OPTIONS (please select)
Biostatistics
Community Health
Disaster Preparedness
Disease Prevention/Health Promotion
Environmental Health
Epidemiology
Global Health
Health Administration
Health Communication
Health Education
Health Policy/Management
Infectious Disease Control
Injury Control/Prevention
Maternal/Child Health
Nutrition
Social/Behavioral Sciences

Example:

Example: If you are reporting on an individual who is studying to be an Occupational Therapist, the Individual’s Profession would be “Allied Health – Student” and the Individual’s Discipline/Specialty would be “Occupational Therapy”.

Example: If you are reporting on an individual who is a Clinical Social Worker, the Individual’s Profession would be “Behavioral Health” and the Individual’s Discipline/Specialty would be “Clinical Social Work”.

EXP-2 - Entering # Trained in the Profession and Discipline

Enter # Trained in this Profession and Discipline
(4) Block 3

Figure 3. EXP-2 - Entering # Trained in the Profession and Discipline

Enter # Trained in this Profession and Discipline:

For each row, enter the number of "Principal" trainees in the profession and discipline listed.

Note
Principal trainees are those who were directly or indirectly supported through your grant. For your grant program, these are the individuals reported on the INDGEN form.

Note
Do not enter counts for faculty, site staff, or other non-trainees.

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

Enter # of Other Trainees in this Profession and Discipline Who Participated in Interprofessional Team-based care
(5) Block 8

Figure 4. EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

Enter # of Other Trainees in this Profession and Discipline Who Participated in Interprofessional Team-based care:

In Column 5 (Block 8), enter the number of "other interprofessional" trainees who participated in team-based care alongside the Principal trainees. Other interprofessional trainees should be those who train along side the Principal trainees.

Note
Counts should not include individuals reported on INDGEN. Individuals reported on INDGEN should be counted in Column 4 as a Principal trainee.

Note
Do not count faculty, site supervisors, or site support staff who are at the site, but not participating in the experiential training.

To Complete the Form: Click on the “Save and Validate” button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.

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EXP-2: Experiential Characteristics - Trainees by Profession/Discipline

EXP-2 - Selecting Training Program and Site Name

EXP-2 - Selecting Training Program and Site Name

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

EXP-2 - Selecting Profession and Discipline/Specialty of Individuals Trained

EXP-2 - Entering # Trained in the Profession and Discipline

EXP-2 - Entering # Trained in the Profession and Discipline

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

EXP-2 - Entering # of Other Interprofessional trainees who participated in team-based care

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