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* *Registered NurseNurse PractitionerPhysicians AssistantPhysicianOtherIs your forensic program staffed by?On Call StaffStaff on shift at time of patient presentationOtherDoes your program receive any type of grant funding specifically for your program?YesNoDoes your program participate in any formalized multidisciplinary team? *YesNoAverage number of cases your program sees in a one year period? *Less than 1011-2526-5051-100101-200201-300Over 300If you selected over 300- estimate the number of patients you are seeingHow many forensic examiners are currently in the program? *012-56-1011-20More than 20Do all patients in need of a forensic exam, recieve one by a forensically trained responder?YesSometimesNoWhat year was your program founded?Has the program operated since then without interruption?YesNoIf your program addresses sexual violence, is the SANE-A or P certification required to practice?YesNoN/A - Our program does not address Sexual ViolenceIs there a minimum number of years of nurses must have practiced before being hired?1 year of general nursing experience2 years of general nursing experience3 or more years of general nursing experienceNo minimumDoes the program have a PAID coordinator that works:Full timePart timeThe coordinator is unpaidThere is no coordinatorPlease select which of the following is true: *Examiners are paid for being "on call"Examiners are not paid for being on callExaminers are paid time and one half for each case they doExaminers are paid a flat rate per caseExaminers are volunteer and do not get paidExaminers are paid salary and not per caseExaminers are paid for court testimony but not for preparation timeExaminers are paid for court prep and testimonyExaminers are NOT paid for court or prep timeWhich type of regular case review or QA is performed by your program?NoneGroup Peer Case ReviewAdministrative Case ReviewPhysician ReviewSubmit
