IND-GEN - SetupPrimary Care Community Prevention Track: Please report data for all residents/fellows participating in the Primary Care Community Prevention Track of your program, including anybody that has participated in maternal health rotations. Primary Care Obstetrics Track: Please report data for all residents/fellows participating in the Primary Care Obstetrics Track of your program. Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period? | Yes (complete IND-GEN) No (click Save and Validate button to proceed to the next form) |
Figure 1. IND-GEN - Setup Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?:
Warning If you have used the INDGEN form before, this answer is pre-selected ‘Yes’ for you. You do not need to answer this question again. Please move ahead to the INDGEN form by using the form list located on the left side of your screen. Warning If you are unable to enter data into the INDGEN form, edit prior records, or see drop-down menus despite the question above being answered ‘Yes’, you have a browser compatibility problem. Please refer to the Getting Started-Browser Settings page at the beginning of this manual. Warning Gray fields in prior records cannot be edited.
Warning Prior records cannot be deleted. |
IND-GEN - Selecting Type of Training Program Figure 2. IND-GEN - Selecting Type of Training Program Type of Training Program: Select each individual's training program by clicking on the drop-down menu under the column labeled "Type of Training Program" and choosing one of the available options.
Note The options available under "Type of Training Program" will prepopulate with information entered and saved in the Training Program Setup Form.
Note This program is no longer able to select "Other" for Type of Training Program. Also, prior records for faculty who had a Type of Training Program of "Other" were deleted. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. Example: The School of Medicine saved two (2) entries in the Training Program Setup form to reflect the type of programs supported by the grant. Under "Type of Training Program" the School of Medicine would see the following options: - Residency program | Internal Medicine
- Residency program | Family Medicine
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IND-GEN - Entering Trainee Unique ID Figure 3. IND-GEN - Entering Trainee Unique ID Trainee Unique ID: Enter a seven (7) character alphanumeric unique identifier for each individual in the textbox in Column 2 (Block 1).
Warning It is the responsibility of each grantee to generate each unique ID and keep a log of all unique IDs used, as these will be required to provide annual updates and 1-year follow-up data for each individual. Note This Block will prepopulate for prior records with data submitted in previous reporting periods. |
IND-GEN - Entering NPI Number Figure 4. IND-GEN - Entering NPI Number NPI Number: Enter the 10-digit National Provider Identifier (NPI) number for each individual in the textbox in Column 2a. To apply for an NPI number, go to: https://nppes.cms.hhs.gov. Note NPIs are required as of AY 2022-2023. |
IND-GEN - Selecting Individual's Training or Awardee Category Figure 5. IND-GEN - Selecting Individual's Training or Awardee Category Select Individual's Training or Awardee Category: Select each individual's training category by clicking on the drop-down menu in Column 3 (Block 2) and choosing one of the following options. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. |
IND-GEN - Selecting Individual's Enrollment/Employment Status Figure 6. IND-GEN - Selecting Individual's Enrollment/Employment Status Select Individual's Enrollment / Employment Status: Select each individual’s current enrollment status in the program by clicking on the drop-down menu in Column 4 (Block 3) and choosing one of the following options. - Full-time
- Both Full-time and Part-time
- Part-time
- On leave of absence
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IND-GEN - Selecting Individuals Gender Figure 7. IND-GEN - Selecting Individuals Gender Select Individual's Gender(s): Select the gender option(s) that apply to each individual by clicking on the drop-down menu under column 5a and choosing all that apply: - Female
- Male
- Transgender or non-binary or another gender
- Not reported
Warning The 'Not Reported' option may not be selected for prior records.
Warning 'Not Reported' cannot be selected in combination with any other options under column 5a. |
IND-GEN - Entering Year of Birth Figure 8. IND-GEN - Entering Year of Birth Enter Year of Birth: Enter each individual’s year of birth at the end of the current reporting period in the textbox in Column 6a. - 1933
- 1934
- 1935
- 1936
- 1937
- 1938
- 1939
- 1940
- 1941
- 1942
- 1943
- 1944
- 1945
- 1946
- 1947
- 1948
- 1949
- 1950
- 1951
- 1952
- 1953
- 1954
- 1955
- 1956
- 1957
- 1958
- 1959
- 1960
- 1961
- 1962
- 1963
- 1964
- 1965
- 1966
- 1967
- 1968
- 1969
- 1970
- 1971
- 1972
- 1973
- 1974
- 1975
- 1976
- 1977
- 1978
- 1979
- 1980
- 1981
- 1982
- 1983
- 1984
- 1985
- 1986
- 1987
- 1988
- 1989
- 1990
- 1991
- 1992
- 1993
- 1994
- 1995
- 1996
- 1997
- 1998
- 1999
- 2000
- 2001
- 2002
- 2003
- 2004
- 2005
- 2006
- 2007
- 2008
- 2009
- 2010
- 2011
- 2012
- 2013
- 2014
- 2015
- 2016
- 2017
- Not Reported
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IND-GEN - Selecting Individual's Ethnicity Figure 9. IND-GEN - Selecting Individual's Ethnicity Select Individual's Ethnicity: Select each individual’s ethnicity by clicking on the drop-down menu in Column 7 (Block 6) and choosing one of the following options: - Hispanic/Latino
- Non-Hispanic/Non-Latino
- Not Reported
Warning The 'Not Reported' option may not be selected for prior records. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. |
IND-GEN - Selecting Individual's Race Figure 10. IND-GEN - Selecting Individual's Race Select Individual's Race: Select each individual’s race by clicking on the drop-down menu in Column 8 (Block 7) and choosing all that apply from the available options. You may select more than one option for individuals of multiple races. - American Indian or Alaska Native
- Asian
- Black or African-American
- Native Hawaiian or Other Pacific Islander
- White
- Not Reported
Warning You may not select "Not Reported" in combination with any other option.
Warning The 'Not Reported' option may not be selected for prior records. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. |
IND-GEN - Selecting if Individual is from a Rural Residential Background Figure 11. IND-GEN - Selecting if Individual is from a Rural Residential Background Select Whether Individual is from a Rural Residential Background: Select whether each individual is from a rural residential background by clicking on the drop-down menu in Column 9 (Block 8) and choosing one of the following options: Warning The 'Not Reported' option may not be selected for prior records. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. Reference Refer to the glossary for a definition of rural setting. |
IND-GEN - Selecting if Individual is from a Disadvantaged Background Figure 12. IND-GEN - Selecting if Individual is from a Disadvantaged Background Select Whether Individual is from a Disadvantaged Background: Select whether each individual is from a disadvantaged background by clicking on the drop-down menu in Column 10 (Block 9) and choosing one of the following options: Warning The 'Not Reported' option may not selected for prior records. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. Reference Refer to the glossary for a definition of disadvantaged background. |
IND-GEN - Selecting Individual's Veteran Status Figure 13. IND-GEN - Selecting Individual's Veteran Status Select Individual's Veteran Status: Select each individual's current veteran status by clicking on the drop-down menu in Column 11 (Block 10) and choosing one of the following options: - Active Duty Military
- Individual is not a Veteran
- National Guard
- Reservist
- Veteran - Prior Service
- Veteran - Retired
- Not Reported
Warning The 'Not Reported' option may not be selected for prior records. Note This column will prepopulate for prior records with data submitted in the previous reporting period. Prior data cannot be altered or deleted. Reference Refer to the glossary for a definition of the various types of veteran statuses.
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IND-GEN - Entering BHW-Funded Financial Award InformationWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 14. IND-GEN - Entering BHW-Funded Financial Award Information Select Whether Individual Received BHW Financial Award?: Select whether each individual received a BHW-funded financial award (i.e., fellowship or stipend) during the current reporting period by clicking on the drop-down menu in Column 12 (Block 11) and choosing one of the following options: Enter Individual's Financial Award Amount (BHW funds only): Direct Financial Support: Enter Individual's Financial Award Amount (BHW funds only): Academic Year Total: This field will populate automatically with the sum of Stipend, Traineeship, and Fellowship. |
IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding Figure 15. IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding Enter # of Academic Years the Individual has Received BHW Funding: Select the cumulative number of academic years that each student has received a BHW-funded financial award by clicking on the drop-down menu under Column 22 and choosing one of the following options: Note The number of academic years receiving BHW-funded financial awards does not need to be consecutive; rather, the cumulative total number of years should be reported. Note If an individual has received money for ½ an academic year, please round up. For example, if a resident has received a financial award for 1 ½ years, please enter 2. Note If an individual received a BHW-funded financial award for the first time during the annual reporting period, select "1" under Block 12. |
IND-GEN - Selecting Individual's Academic or Training Year Figure 16. IND-GEN - Selecting Individual's Academic or Training Year Select Individual's Academic or Training Year: Select each student's current training year by clicking on the drop-down menu under Block 15 and choosing one of the following options: - Residency Year 1
- Residency Year 2
- Residency Year 3
- Residency Year 4
- Residency Year 5
- Training Year 1
- Training Year 2
- Training Year 3 or more
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IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training Figure 17. IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training Select any HHS Priority Topic Area on which an Individual Received Training: Use the dropdown menu in Column 26b to select all that apply from the list of topic areas on which the individual was trained. - Individual received provider resilience training
- Individual received training in Health Equity
- Individual received training in medications for opioid use disorder (MOUD)
- Individual received training in substance use treatment
- Individual received training on integrated behavioral health in primary care
- Individual received training related to maternal health
- None of the above
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IND-GEN - Selecting Profession and Discipline/Specialty Figure 18. IND-GEN - Selecting Profession and Discipline/Specialty Select Individual's Profession: Select the individual’s profession by clicking on the drop-down menu in Column 26c and selecting one of the available options.- Medicine
- Medicine - Student
- Physician Assistant - Student
Select Individual's Primary Discipline/Specialty: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 26d 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.- MEDICAL OPTIONS (please select)
- Family Medicine
- Internal Medicine
- Internal Medicine/Pediatrics
- Pediatrics
- MEDICAL SCHOOL OPTION (please select)
- Medical School
- PHYSICIAN ASSISTANT OPTION (please select)
- Physician Assistant
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IND-GEN - Entering Total # of Patients Treated during Academic Year Figure 19. IND-GEN - Entering Total # of Patients Treated during Academic Year Enter Total # of Patients Treated during Academic Year: In Column 27c, enter the total number of patients treated by each individual during the academic year.
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IND-GEN - Entering Telehealth Training Information Figure 20. IND-GEN - Entering Telehealth Training Information Training in Telehealth: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in telehealth during the current reporting period by clicking on the drop-down menu in Column 27d and choosing one of the following options:Training in Telehealth: Enter # of Contact Hours: - If the individual received clinical or experiential training in Telehealth, enter the total number of hours spent offering telehealth services and/or participating in training about how to offer telehealth services during the current reporting period in the textbox in Column 27e.
- If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27e blank.
Training in Telehealth: Enter # of Patient Encounters: - If the individual received clinical or experiential training in Telehealth, enter the number of telehealth patient encounters in this setting during the current reporting period in Column 27f.
- If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27f blank.
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IND-GEN - Entering Training Information in a Primary Care SettingWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 21. IND-GEN - Entering Training Information in a Primary Care Setting Training in a Primary Care Setting: Select Whether Individual Received Training: Select whether each resident or fellow received clinical or experiential training in a primary care setting during the current reporting period by clicking on the drop-down menu in Column 28 (Block 17) and choosing one of the following options: Training in a Primary Care Setting: Enter # of Contact Hours: - If the resident or fellow received clinical or experiential training in a primary care setting, enter the total number of hours spent in this type of setting during the current reporting period in the textbox in Column 29 (Block 17a).
- If the resident or fellow did not receive clinical or experiential training in a primary care setting, leave the textbox in Column 29 (Block 17a) blank.
Training in a Primary Care Setting: Enter # of Patient Encounters: - If the resident or fellow received clinical or experiential training in a primary care setting, enter the total number of patient encounters in this type of setting during the current reporting period in the textbox in Column 30 (Block 17b).
- If the resident or fellow did not receive clinical or experiential training in a primary care setting, leave the textbox in Column 30 (Block 17b) blank.
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IND-GEN - Entering Training Information in a Medically Underserved CommunityWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 22. IND-GEN - Entering Training Information in a Medically Underserved Community Training in a Medically Underserved Community: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in a medically underserved community during the current reporting period by clicking on the drop-down menu in Column 31 and choosing one of the following options: Training in a Medically Underserved Community: Enter # of Contact Hours: -
If the individual received clinical or experiential training in a MUC, enter the total number of hours spent in this type of setting during the current reporting period in the textbox in Column 32. -
If the individual did not receive clinical or experiential training in a MUC, leave the textbox blank. Training in a Medically Underserved Community: Enter # of Patient Encounters : - If the individual received clinical or experiential training in a MUC, enter the number of patient encounters in a medically underserved community during the current reporting period in Column 32a.
- If the individual did not receive clinical or experiential training in a MUC, leave the textbox in Column 32a blank.
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IND-GEN - Entering Training Information in a Rural AreaWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 23. IND-GEN - Entering Training Information in a Rural Area Training in a Rural Area: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in a rural area during the current reporting period by clicking on the drop-down menu in Column 33 (Block 19) and choosing one of the following options: Training in a Rural Area: Enter # of Contact Hours: - If the individual received clinical or experiential training in a rural area, enter the total number of hours spent in this type of setting during the current reporting period in the textbox.
- If the individual did not receive clinical or experiential training in a rural area, leave the textbox blank.
Training in a Rural Area: Enter # of Patient Encounters: - If the individual received clinical or experiential training in a rural area, enter the total number of patient encounters in this setting during the current reporting period in Column 34aa.
- If the individual did not receive clinical or experiential training in a rural area, leave the textbox blank.
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IND-GEN - Selecting Whether Individual Left the Program Before Completion Figure 24. IND-GEN - Selecting Whether Individual Left the Program Before Completion Select Whether Individual Left the Program Before Completion: Select whether each individual permanently left their residency or fellowship program or faculty development program before completion during the current reporting period by clicking on the drop-down menu in Column 36 (Block 21) and choosing one of the following options: |
IND-GEN - Entering Graduation/Completion InformationWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 25. IND-GEN - Entering Graduation/Completion Information Select Whether Individual Graduated/Completed the Program: Select whether each individual completed from their training program during the current reporting period by clicking on the drop-down menu in Column 37 (Block 22) and choosing one of the following options: Select Individual's Post-Graduation/Completion Intentions: - Individual intends to apply for NHSC Loan Repayment
- Individual intends to practice or continue practicing in a medically underserved area
- Individual intends to practice or continue practicing in a primary care setting
- Individual intends to practice or continue practicing in a rural area
- None of the above
- Not Reported
- N/A
Warning None of the above, Not reported, and N/A cannot be selected in combination with any other option. 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. |
IND-GEN - Entering Individual's Employment DataWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 26. IND-GEN - Entering Individual's Employment Data Select whether Employment Data is available?: Select whether employment data are available by clicking on the drop-down menu in Column 56 and choosing one of the following options: - Yes
- Yes (outside U.S.)
- No
- N/A
Select Whether Your Organization Hired this Individual: Select Whether a Partner Organization Hired this Individual: Enter Zip Code: Enter the zip code for the individual’s Employment Location. Enter City: Enter State: Select Type of Employment: - If ‘Yes’ was selected in Column 56, identify the individual’s type of employment by clicking on the drop-down menu and selecting the best option among those listed below.
- If ‘No’ or ‘Yes (outside U.S.)' was selected, select 'N/A' in Column 60.
- Academic Institution
- Academic Medical Center
- Area Health Education Center
- Certified Community Behavioral Health Clinic (CCBHC)
- Community Behavioral Health/Mental Health Center
- Community Health Center (CHC)
- Critical Access Hospital
- Federal Government
- FQHC or Look-Alike
- Health Department (local/state/tribal)
- Hospital (non-academic)
- Indian Health Service (IHS)/Tribal/Urban Indian Health Center
- Nursing Home
- Other Clinical Health Setting
- Other Community-Based Organization
- Other Long-term Care Facility
- Other Specialty Clinic
- Private Industry
- Private Practice
- Residential Living Facility (including independent and assisted living)
- Rural Health Clinic
- School-based Clinic
- State or Local Government
- US Armed Forces
- Veterans Affairs Healthcare (e.g. VA hospital or clinic)
- Pursuing Additional Education or Training
- Not Currently Employed
- N/A
Warning For Column 60, None of the above, not reported, and N/A cannot be selected in combination with any other option. NoteIf an individual has completed the program but is not currently employed, please select “Yes” for Column 56 (Select whether employment data is available). Leave the zip code, city, and state blank and select "N/A" for whether you or a partner organization hired the individual (Columns 56a and 56b). Then, select “Not Currently Employed” for Column 60 and N/A for Column 61.
Note You must also select “N/A” if you indicated that the person is “Not Currently Employed” in Column 60.
Note Leave the zip code blank if you indicated that the person is “Not Currently Employed” in Column 60. |
IND-GEN - Selecting Individual's Employment Location Settings Figure 27. IND-GEN - Selecting Individual's Employment Location Settings Select Individual's Employment Location Settings: For each individual, use the drop-down menu in Column 61 to select all that apply from the list of employment location settings. - Medically Underserved Community
- National Health Service Corps (NHSC)-Approved Site
- Primary Care Setting
- Rural Area
- None of the Above
- N/A
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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