EXP-3 | HRSA EHBs

EXP-3 - Selecting Type of Training Program

Warning

Only complete the EXP-3 form if you are an NEPQR-IPCP: BHI awardee. If you are a NEPQR-PRNP awardee, complete the EXP-2 form.

Warning

EXP-1 must be completed and validated before completing EXP-3. Please read instructions carefully. EXP-3 will appear blank; however, drop-down selections will populate with your completed EXP-1 training sites.

Type of Training Program
(1)

Figure 1. EXP-3 - Selecting Type of Training Program

Type of Training Program: The EXP-3 subform captures information about the composition of each Interprofessional team at each site used during the current reporting period. To begin completing this subform, select a training program by clicking on the drop-down menu under Column 1 and choosing one of the available options. Options are populated from the Training Program Setup Form.

EXP-3 - Selecting Site Name

Site Name
(2) Block 1

Figure 2. EXP-3 - Selecting Site Name

Site Name: Select a site used during the current reporting period by clicking on the drop-down menu under Column 2 and choosing one of the available options. The options available under "Site Name" will prepopulate with information entered and saved in the EXP-1 subform. Only sites marked as "Used during the Reporting Period" will appear as options.

EXP-3 - Selecting Team Number

Select Team Number
(3) Block 7b

Figure 3. EXP-3 - Selecting Team Number

Select Team Number: Assign a team number for each Interprofessional team trained at each site by clicking on the drop-down menu under Column 3.

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EXP-3 - Selecting Profession and Discipline of Team Members

Select Profession of Team Members	Select Discipline/Specialty of Team Members
(4)	(4a)

Figure 4. EXP-3 - Selecting Profession and Discipline of Team Members

Select Profession of Team Members: Select the individual’s profession by clicking on the drop-down menu in Column 4 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 Team Members: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 4a 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
EMT/Paramedic
Home Health Aide
Medical Assistant
Midwife (non-nurse)
Nurse Assistant/Patient Care Associate
Nutritionist/Dietician
Occupational Therapy
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
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
Diagnostic Radiology
Emergency Medicine
Family Medicine
General Surgery
Geriatric Medicine
Geriatric Psychiatry
Integrative Medicine
Internal Medicine
Internal Medicine/Family Medicine
Internal Medicine/Pediatrics
Medical Genetics
Medical Oncology
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Palliative Care
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Preventive Medicine/Aerospace Medicine
Preventive Medicine/Family Medicine
Preventive Medicine/Internal Medicine
Preventive Medicine/Occupational Medicine
Preventive Medicine/Pediatrics
Preventive Medicine/Public Health
Preventive Medicine/Sports Medicine
Psychiatry
Radiation Oncology
Thoracic Surgery
Urology
Vascular Surgery
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
Doula
Exercise Physiology
Facility Administrator
Firefighter
Health Informatics/Information Technology
Law Enforcement
Lay/Family Caregiver
Medical Laboratory Sciences
Office/Support Staff
Optometry
Pharmacy
Podiatry
Profession Not Listed
Radiologic Technology
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
Direct Service Worker
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:

If you are reporting on an individual who is a Plastic Surgeon, the Individual’s Profession would be “Medicine” and the Individual’s Discipline/Specialty would be “Plastic Surgery”.

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-3 - Entering # of Team Members

Enter # of Team Members in this Profession and Discipline
(5) Block 7b

Figure 5. EXP-3 - Entering # of Team Members

Enter # of Team Members in this Profession and Discipline: Enter the number of individuals in each profession and discipline that was selected in the previous step in the textbox under Column 5.
Repeat this process to capture the total number of individuals who participated in IPCP training at each site during the current reporting period.

EXP-3 - Selecting Type of Site Used

Select Type of Site Used
(6)

Figure 6. EXP-3 - Selecting Type of Site Used

Select Type of Site Used: Following the selection of a training site in EXP-1, the associated type of site will be automatically populated when the save and validate button is selected.

Academic institution
Acute Care for the Elderly (ACE) Units
Acute care services
Aerospace operations setting
Ambulatory practice sites
Certified Community Behavioral Health Clinic (CCBHC)
Community Health Center (CHC)
Community Care Programs for Elderly Mentally Challenged Individuals
Community Mental Health Center
Community-based Organization
Critical Access Hospital
Day and Home Care Programs (e.g. Home Health)
Extended care facilities
Dentist Office
Federal Government - Department of Defense / Military
Emergency Room
Federal and State Bureau of Prisons
Federal Government Office or Agency
Federal Government - Other
FQHC or look-alike
Hospice
Hospital
National health association
Independent Living Facility
Indian Health Service (IHS) Site
International Nonprofit/Nongovernmental Organization
Local Government Office or Agency
Local Health Department
Long-Term Care Facility
Mobile Clinic/Site
Nurse Managed Health Clinics
Nursing Home
Other
Other Community Health Center (e.g. free clinic)
Other Oral Health Facility
Physician Office
Surgery Clinic
Program of All Inclusive Care for the Elderly
Veterans Affairs Healthcare (e.g. VA Hospital or clinic)
Residential Living Facility
Rural Health Clinic
School-based Clinic
Senior Centers
Specialty Clinics (e.g. mental health practice/rehabilitation/substance abuse clinic)
State Government Office or Agency
State Health Department
Tribal Health Department
Tribal Organization

Warning
Site types are linked to the name of training sites in EXP-1. To change the associated site type with a particular site name, return to EXP-1.

EXP-3 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located
(7)

Figure 7. EXP-3 - Selecting Type of Setting Where the Site was Located

Select Type of Setting Where the Site was Located: Following the selection of a training site in EXP-1, the associated settings will be automatically populated when the save and validate button is selected.

Medically underserved community
Primary Care Setting
Rural area
None of the above

Warning
Site settings are linked to the name of training sites in EXP-1. To change the associated site settings with a particular site name, return to EXP-1.

Note
If you are a NEPQR-PRNP awardee, work with your PO to submit your APR with EXP-3 validation errors.

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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Program Manual

Nurse Education, Practice, Quality and Retention Interprofessional Collaborative Practice (IPCP)

EXP-3: Experiential Characteristics - Team Based Care

EXP-3 - Selecting Type of Training Program

EXP-3 - Selecting Type of Training Program

EXP-3 - Selecting Site Name

EXP-3 - Selecting Site Name

EXP-3 - Selecting Team Number

EXP-3 - Selecting Team Number

EXP-3 - Selecting Profession and Discipline of Team Members

EXP-3 - Selecting Profession and Discipline of Team Members

EXP-3 - Entering # of Team Members

EXP-3 - Entering # of Team Members

EXP-3 - Selecting Type of Site Used

EXP-3 - Selecting Type of Site Used

EXP-3 - Selecting Type of Setting Where the Site was Located

EXP-3 - Selecting Type of Setting Where the Site was Located

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