Pressure Ulcer Prevention and Treatment

In order to evaluate this project for our funding source (the Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services), we ask that this questionnaire be completed by all individuals who view the Prevention and Treatment of Pressure Ulcers website. Your answers are extremely valuable. They will provide the basis for future decisions about the best way to provide distance education in geriatrics for health professionals. No information that you share will be shared with other organizations, this is completely anonymous and no cookies are stored on your machine. Thank you for you cooperation.

If you have already filled out this information, please enter your login number.

Login # (Last 6 digits of phone#):

Last 6 digits of phone number: (this will be your login numbernext time you visit) Gender: Male Female What is your age?

What is your racial background? American Indian or Alaska Native Under-represented Asian subgroup* Asian (not under-represented) Black or African American Hispanic or Latino Native Hawaiian/Other Pacific Islander White or Caucasian Other (please specify) *Refers to any Asian other than Chinese, Fillipino, Japanese, Korean, or Asian Indian

In what city/county/state do you work or practice: City: or County: State:

Please indicate the highest level of education completed: High School Some College College Graduate Some Graduate Training Graduate Degree Other:

What degrees/certifications do you currently hold? (check all that apply) Select multiple by holding "Control","Alt", "Apple", or Command key while clicking your mouse. **Note: Do not select more than 5. If more than 5 the last values will be trimmed BA BS BSN BSW RN CNP MA MS MSN MSW M.Ed MPH MD M.Div Ph.D Ed.D DSW D.N.Sc/ND D.Pharm D.Min DDS PsyD Other If other, please specify - If more than one, please put " ; " (semicolon) between each.

Have you ever received any formal training in gerontology or geriatrics? Yes No If yes, please mark all that apply: Select multiple by holding "Control","Alt", "Apple", or Command key while clicking your mouse. **Note: Do not select more than 5. If more than 5 the last values will be trimmed Attended Conferences, Workshops, or other Continuing Education Programs in Geriatrics/Gerontology Completed some individual courses in Geriatrics/Gertontology Completed requirements for a Minor in Geriatrics/Gerontology Completed Bachelor's Degree in Gerontology Obtained graduate certificate in aging studies Completed a Master's Degree in Gerontology Pass and ANA/AMA Gerontological/Geriatrics certifcation exam Other If other, please specify - If more than one, please put " ; " (semicolon) between each.

Please pick the category that best describes your discipline/profession (check one) Primary Care Disciplines Family Medicine General Internal Medicine Physician Assistant Nurse Practitioner Nurse-Midwife Dentistry Podiatry   Discipline/Profession Not Related to Health Care Law (Attorney, Paralegal) Protective Services Other, specify:   Other Health Professions Allopathic Medicine Osteopathic Medicine Nurse Anesthetist Other Advanced Practice Nurse (MSN) Undergraduate Nurse (RN/Diploma/BSN) Chiropractic Dental Public Health Health Administration Public Health Preventive Medicine Pharmacy Clinical/Counseling Psychology Social Work Other, specify . Allied Health Disciplines Clinical Lab Sciences (Lab Tech) Food & Nutrition Services (DIT or Tech) Gerontology Health Education Health Information (Med. Records/Transcript) Rehab (Therapist or assistant in OT, PT,       Recreational/Activities, Speech/Audio) Dental Hygienist/Dental Assistant/ Denatl lab tech Other Technician (EEG, EKG, EMT) Assistants (CNAs, STNA's, Home Health Aides, Medical Assist.) Other, specify

What is your Position/Job Title:

If you hold a job, what is your primary place of employment? (check one) Ambulatory Care/Outpatient Clinic Government Group Medical Practice Home Care Hospice Hospital Individual Medical Practice Medical School Nursing Home Assisted Living/CCRC School of Public Health School of Social Work Other Health Professions Schools Other, please specify

Do you spend 50% of your time working with adults 60 years of age and older OR dealing with aging related issues? Yes No If yes, for about how many years have you been doing this?