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Health Resources and Services Administration
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Academic Year: 2022-2023
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Bureau of Health Workforce
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OMB Number: 0915-0061
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Annual Performance Report
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OMB Expiration Date: 01/31/2025
EXP-3: Experiential Characteristics - Team Based Care
EXP-3 - Selecting Type of Training ProgramWarning
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. 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 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 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. - 1
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EXP-3 - Selecting Profession and Discipline of Team Members 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
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 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 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 Center (CCBHC)
- Community Care Programs for Elderly Mentally Challenged Individuals
- Community Health Center (CHC)
- Community Mental Health Center
- Community-based Organization
- Critical Access Hospital
- Day and Home Care Programs (e.g. Home Health)
- Dentist Office
- Emergency Room
- Extended care facilities
- Federal and State Bureau of Prisons
- Federal Government - Department of Defense / Military
- Federal Government - Other
- Federal Government Office or Agency
- FQHC or look-alike
- Hospice
- Hospital
- 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
- National health association
- Nurse Managed Health Clinics
- Nursing Home
- Other
- Other Community Health Center (e.g. free clinic)
- Other Oral Health Facility
- Physician Office
- Program of All Inclusive Care for the Elderly
- 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
- Surgery Clinic
- Tribal Health Department
- Tribal Organization
- Veterans Affairs Healthcare (e.g. VA Hospital or clinic)
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 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. 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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