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139.127.254.162  Public Scan

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URL: https://redcap.upstate.edu/surveys/?s=va4vTLSwtM5rKS8f
Submission: On February 21 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: form — POST /surveys/index.php?s=va4vTLSwtM5rKS8f

<form action="/surveys/index.php?s=va4vTLSwtM5rKS8f" enctype="multipart/form-data" target="_self" method="post" name="form" id="form"><input type="hidden" name="redcap_csrf_token" value="">
  <div>
    <script type="text/javascript">
      if (typeof lang == 'undefined') {
        var lang = {}
      };
      lang.global_143 = 'Checked';
      lang.global_144 = 'Unchecked';
    </script>
    <script type="text/javascript">
      var missing_data_replacement_js = '______';
      var piping_receiver_class_field_js = '.piping_receiver.piperec-';
    </script>
    <span id="maxchecked_tag_label" class="" style="display:none;z-index:1000;" data-rc-lang="data_entry_421">Cannot select choice! The maximum number of choices has been selected.</span><span id="matrix_rank_remove_label" class="opacity75"
      style="display:none;" data-rc-lang="data_entry_203">Value removed!</span>
    <div id="questiontable_loading" style="display: none; visibility: visible;">
      <img alt="Loading..." src="/redcap_v12.4.22/Resources/images/progress_circle.gif"> <span data-rc-lang="data_entry_64">Loading...</span>
    </div>
    <script type="text/javascript">
      setTimeout(function() {
        document.getElementById('questiontable_loading').style.visibility = 'visible';
      }, 750);
    </script>
    <table role="presentation" class="form_border container-fluid" style="display: table;" id="questiontable">
      <tbody class="formtbody">
        <tr id="location-sh-tr" sq_id="{}" style="display: table-row;">
          <td class="header toolbar" colspan="3">
            <div data-mlm-field="location" data-mlm-type="header">
              <div class="rich-text-field-label">
                <div class="rich-text-field-label">
                  <h5>Part 1: Demographics</h5>
                </div>
              </div>
            </div>
          </td>
        </tr>
        <tr id="location-tr" sq_id="location" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-location">
              <div data-kind="field-label">
                <div data-mlm-field="location" data-mlm-type="label"> Where in the United States is your PGY1 Pharmacy Residency Program located?<br> (Please see attachment below for states in US Census regions)</div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="location" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-location">
              <div class="choicevert"><input type="radio" id="opt-location_1" tabindex="0" name="location___radio" aria-labelledby="label-location label-location-1" onclick="document.forms['form'].location.value=this.value;" value="1"> <label
                  data-mlm-field="location" data-mlm-type="enum" data-mlm-value="1" id="label-location-1" for="opt-location_1" class="mc">Northeast</label></div>
              <div class="choicevert"><input type="radio" id="opt-location_2" tabindex="0" name="location___radio" aria-labelledby="label-location label-location-2" onclick="document.forms['form'].location.value=this.value;" value="2"> <label
                  data-mlm-field="location" data-mlm-type="enum" data-mlm-value="2" id="label-location-2" for="opt-location_2" class="mc">Midwest</label></div>
              <div class="choicevert"><input type="radio" id="opt-location_3" tabindex="0" name="location___radio" aria-labelledby="label-location label-location-3" onclick="document.forms['form'].location.value=this.value;" value="3"> <label
                  data-mlm-field="location" data-mlm-type="enum" data-mlm-value="3" id="label-location-3" for="opt-location_3" class="mc">South</label></div>
              <div class="choicevert"><input type="radio" id="opt-location_4" tabindex="0" name="location___radio" aria-labelledby="label-location label-location-4" onclick="document.forms['form'].location.value=this.value;" value="4"> <label
                  data-mlm-field="location" data-mlm-type="enum" data-mlm-value="4" id="label-location-4" for="opt-location_4" class="mc">West</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('location','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="location_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="regionspic-tr" sq_id="regionspic">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-11" colspan="2">
            <div data-kind="field-label">
              <div data-mlm-field="regionspic" data-mlm-type="label"> </div>
            </div>
            <div class="div_attach">
              <span data-rc-lang="design_205">Attachment:</span> &nbsp; <img src="/redcap_v12.4.22/Resources/images/picture.png" alt="">
              <a class="rc_attach" target="_blank" href="/surveys/index.php?pid=3903&amp;__passthru=DataEntry%2Ffile_download.php&amp;type=attachment&amp;field_name=regionspic&amp;hidden_edit=0&amp;record=185&amp;event_id=5250&amp;doc_id_hash=c078e0400ac4c27c2f6d2969ef807fd607bf9244&amp;instance=1&amp;id=44178&amp;s=va4vTLSwtM5rKS8f" onclick="incrementDownloadCount('',this);"><span data-kind="file-name">1280px-Census_Regions_and_Division_of_the_United_States.svg.png</span></a>&nbsp;
              <span aria-hidden="true">(<span data-kind="file-size">0.22</span> MB)</span>
            </div>
          </td>
        </tr>
        <tr id="site-tr" sq_id="site" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-site">
              <div data-kind="field-label">
                <div data-mlm-field="site" data-mlm-type="label"> What institution type best describes the site of your PGY1 Pharmacy Residency Program? </div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="site" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-site">
              <div class="choicevert"><input type="radio" id="opt-site_1" tabindex="0" name="site___radio" aria-labelledby="label-site label-site-1" onclick="document.forms['form'].site.value=this.value;doBranching('site');" value="1"> <label
                  data-mlm-field="site" data-mlm-type="enum" data-mlm-value="1" id="label-site-1" for="opt-site_1" class="mc">Federal government hospital</label></div>
              <div class="choicevert"><input type="radio" id="opt-site_2" tabindex="0" name="site___radio" aria-labelledby="label-site label-site-2" onclick="document.forms['form'].site.value=this.value;doBranching('site');" value="2"> <label
                  data-mlm-field="site" data-mlm-type="enum" data-mlm-value="2" id="label-site-2" for="opt-site_2" class="mc">Academic medical center</label></div>
              <div class="choicevert"><input type="radio" id="opt-site_3" tabindex="0" name="site___radio" aria-labelledby="label-site label-site-3" onclick="document.forms['form'].site.value=this.value;doBranching('site');" value="3"> <label
                  data-mlm-field="site" data-mlm-type="enum" data-mlm-value="3" id="label-site-3" for="opt-site_3" class="mc">Community teaching or nonteaching hospital</label></div>
              <div class="choicevert"><input type="radio" id="opt-site_4" tabindex="0" name="site___radio" aria-labelledby="label-site label-site-4" onclick="document.forms['form'].site.value=this.value;doBranching('site');" value="4"> <label
                  data-mlm-field="site" data-mlm-type="enum" data-mlm-value="4" id="label-site-4" for="opt-site_4" class="mc">Psychiatric or long-term care hospital</label></div>
              <div class="choicevert"><input type="radio" id="opt-site_5" tabindex="0" name="site___radio" aria-labelledby="label-site label-site-5" onclick="document.forms['form'].site.value=this.value;doBranching('site');" value="5"> <label
                  data-mlm-field="site" data-mlm-type="enum" data-mlm-value="5" id="label-site-5" for="opt-site_5" class="mc">Other (Please specify)</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('site','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="site_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="otherinstutiontype-tr" sq_id="otherinstutiontype" req="1" style="display: none;">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-otherinstutiontype">
              <div data-kind="field-label">
                <div data-mlm-field="otherinstutiontype" data-mlm-type="label"> Other</div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-required="true" aria-labelledby="label-otherinstutiontype" class="x-form-text x-form-field " type="text" name="otherinstutiontype" value=""
                tabindex="0"></span>
            <div id="otherinstutiontype_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="beds-tr" sq_id="beds" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-beds">
              <div data-kind="field-label">
                <div data-mlm-field="beds" data-mlm-type="label"> How many beds are there at the institutional site of your PGY1 Pharmacy Residency Program? </div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="beds" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-beds">
              <div class="choicevert"><input type="radio" id="opt-beds_1" tabindex="0" name="beds___radio" aria-labelledby="label-beds label-beds-1" onclick="document.forms['form'].beds.value=this.value;" value="1"> <label data-mlm-field="beds"
                  data-mlm-type="enum" data-mlm-value="1" id="label-beds-1" for="opt-beds_1" class="mc">&lt; 200</label></div>
              <div class="choicevert"><input type="radio" id="opt-beds_2" tabindex="0" name="beds___radio" aria-labelledby="label-beds label-beds-2" onclick="document.forms['form'].beds.value=this.value;" value="2"> <label data-mlm-field="beds"
                  data-mlm-type="enum" data-mlm-value="2" id="label-beds-2" for="opt-beds_2" class="mc">200 - 399</label></div>
              <div class="choicevert"><input type="radio" id="opt-beds_3" tabindex="0" name="beds___radio" aria-labelledby="label-beds label-beds-3" onclick="document.forms['form'].beds.value=this.value;" value="3"> <label data-mlm-field="beds"
                  data-mlm-type="enum" data-mlm-value="3" id="label-beds-3" for="opt-beds_3" class="mc">400 - 599</label></div>
              <div class="choicevert"><input type="radio" id="opt-beds_4" tabindex="0" name="beds___radio" aria-labelledby="label-beds label-beds-4" onclick="document.forms['form'].beds.value=this.value;" value="4"> <label data-mlm-field="beds"
                  data-mlm-type="enum" data-mlm-value="4" id="label-beds-4" for="opt-beds_4" class="mc">600 - 799</label></div>
              <div class="choicevert"><input type="radio" id="opt-beds_5" tabindex="0" name="beds___radio" aria-labelledby="label-beds label-beds-5" onclick="document.forms['form'].beds.value=this.value;" value="5"> <label data-mlm-field="beds"
                  data-mlm-type="enum" data-mlm-value="5" id="label-beds-5" for="opt-beds_5" class="mc">≥ 800</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('beds','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="beds_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="yearsashpaccredited-tr" sq_id="yearsashpaccredited" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-yearsashpaccredited">
              <div data-kind="field-label">
                <div data-mlm-field="yearsashpaccredited" data-mlm-type="label"> How long has your PGY1 Pharmacy Residency Program been accredited by the American Society of Health-System Pharmacists? </div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="yearsashpaccredited" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-yearsashpaccredited">
              <div class="choicevert"><input type="radio" id="opt-yearsashpaccredited_1" tabindex="0" name="yearsashpaccredited___radio" aria-labelledby="label-yearsashpaccredited label-yearsashpaccredited-1"
                  onclick="document.forms['form'].yearsashpaccredited.value=this.value;" value="1"> <label data-mlm-field="yearsashpaccredited" data-mlm-type="enum" data-mlm-value="1" id="label-yearsashpaccredited-1" for="opt-yearsashpaccredited_1"
                  class="mc">&lt; 1 year</label></div>
              <div class="choicevert"><input type="radio" id="opt-yearsashpaccredited_2" tabindex="0" name="yearsashpaccredited___radio" aria-labelledby="label-yearsashpaccredited label-yearsashpaccredited-2"
                  onclick="document.forms['form'].yearsashpaccredited.value=this.value;" value="2"> <label data-mlm-field="yearsashpaccredited" data-mlm-type="enum" data-mlm-value="2" id="label-yearsashpaccredited-2" for="opt-yearsashpaccredited_2"
                  class="mc">1 - 5 years</label></div>
              <div class="choicevert"><input type="radio" id="opt-yearsashpaccredited_3" tabindex="0" name="yearsashpaccredited___radio" aria-labelledby="label-yearsashpaccredited label-yearsashpaccredited-3"
                  onclick="document.forms['form'].yearsashpaccredited.value=this.value;" value="3"> <label data-mlm-field="yearsashpaccredited" data-mlm-type="enum" data-mlm-value="3" id="label-yearsashpaccredited-3" for="opt-yearsashpaccredited_3"
                  class="mc">6 - 10 years</label></div>
              <div class="choicevert"><input type="radio" id="opt-yearsashpaccredited_4" tabindex="0" name="yearsashpaccredited___radio" aria-labelledby="label-yearsashpaccredited label-yearsashpaccredited-4"
                  onclick="document.forms['form'].yearsashpaccredited.value=this.value;" value="4"> <label data-mlm-field="yearsashpaccredited" data-mlm-type="enum" data-mlm-value="4" id="label-yearsashpaccredited-4" for="opt-yearsashpaccredited_4"
                  class="mc">11 - 15 years</label></div>
              <div class="choicevert"><input type="radio" id="opt-yearsashpaccredited_5" tabindex="0" name="yearsashpaccredited___radio" aria-labelledby="label-yearsashpaccredited label-yearsashpaccredited-5"
                  onclick="document.forms['form'].yearsashpaccredited.value=this.value;" value="5"> <label data-mlm-field="yearsashpaccredited" data-mlm-type="enum" data-mlm-value="5" id="label-yearsashpaccredited-5" for="opt-yearsashpaccredited_5"
                  class="mc">&gt; 15 years</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('yearsashpaccredited','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="yearsashpaccredited_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="affiliation-tr" sq_id="affiliation" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-affiliation">
              <div data-kind="field-label">
                <div data-mlm-field="affiliation" data-mlm-type="label"> Is your PGY1 Pharmacy Residency Program affiliated with a school of higher learning? </div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="affiliation" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-affiliation">
              <div class="choicevert"><input type="radio" id="opt-affiliation_1" tabindex="0" name="affiliation___radio" aria-labelledby="label-affiliation label-affiliation-1"
                  onclick="document.forms['form'].affiliation.value=this.value;doBranching('affiliation');" value="1"> <label data-mlm-field="affiliation" data-mlm-type="enum" data-mlm-value="1" id="label-affiliation-1" for="opt-affiliation_1"
                  class="mc">Pharmacy School</label></div>
              <div class="choicevert"><input type="radio" id="opt-affiliation_2" tabindex="0" name="affiliation___radio" aria-labelledby="label-affiliation label-affiliation-2"
                  onclick="document.forms['form'].affiliation.value=this.value;doBranching('affiliation');" value="2"> <label data-mlm-field="affiliation" data-mlm-type="enum" data-mlm-value="2" id="label-affiliation-2" for="opt-affiliation_2"
                  class="mc">Medical School</label></div>
              <div class="choicevert"><input type="radio" id="opt-affiliation_3" tabindex="0" name="affiliation___radio" aria-labelledby="label-affiliation label-affiliation-3"
                  onclick="document.forms['form'].affiliation.value=this.value;doBranching('affiliation');" value="3"> <label data-mlm-field="affiliation" data-mlm-type="enum" data-mlm-value="3" id="label-affiliation-3" for="opt-affiliation_3"
                  class="mc">Both Pharmacy and Medical Schools</label></div>
              <div class="choicevert"><input type="radio" id="opt-affiliation_4" tabindex="0" name="affiliation___radio" aria-labelledby="label-affiliation label-affiliation-4"
                  onclick="document.forms['form'].affiliation.value=this.value;doBranching('affiliation');" value="4"> <label data-mlm-field="affiliation" data-mlm-type="enum" data-mlm-value="4" id="label-affiliation-4" for="opt-affiliation_4"
                  class="mc">Not affiliated</label></div>
              <div class="choicevert"><input type="radio" id="opt-affiliation_5" tabindex="0" name="affiliation___radio" aria-labelledby="label-affiliation label-affiliation-5"
                  onclick="document.forms['form'].affiliation.value=this.value;doBranching('affiliation');" value="5"> <label data-mlm-field="affiliation" data-mlm-type="enum" data-mlm-value="5" id="label-affiliation-5" for="opt-affiliation_5"
                  class="mc">Other (Please specify)</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('affiliation','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="affiliation_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="other_school-tr" sq_id="other_school" req="1" style="display: none;">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-other_school">
              <div data-kind="field-label">
                <div data-mlm-field="other_school" data-mlm-type="label"> Other</div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-required="true" aria-labelledby="label-other_school" class="x-form-text x-form-field " type="text" name="other_school" value=""
                tabindex="0"></span>
            <div id="other_school_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
        </tr>
        <tr id="numberresidents-tr" sq_id="numberresidents" req="1">
          <td class="labelrc questionnum col-1" valign="top"></td>
          <td class="labelrc col-6"><label class="fl" id="label-numberresidents">
              <div data-kind="field-label">
                <div data-mlm-field="numberresidents" data-mlm-type="label"> How many residents does your PGY1 Pharmacy Residency Program have? </div>
                <div class="requiredlabel" aria-label="Question required.">* <span data-rc-lang="data_entry_39">must provide value</span></div>
              </div>
            </label></td>
          <td class="data col-5"><span data-kind="field-value"><input name="numberresidents" value="" tabindex="-1" class="hiddenradio" aria-labelledby="label-numberresidents">
              <div class="choicevert"><input type="radio" id="opt-numberresidents_1" tabindex="0" name="numberresidents___radio" aria-labelledby="label-numberresidents label-numberresidents-1"
                  onclick="document.forms['form'].numberresidents.value=this.value;" value="1"> <label data-mlm-field="numberresidents" data-mlm-type="enum" data-mlm-value="1" id="label-numberresidents-1" for="opt-numberresidents_1" class="mc">1 -
                  3</label></div>
              <div class="choicevert"><input type="radio" id="opt-numberresidents_2" tabindex="0" name="numberresidents___radio" aria-labelledby="label-numberresidents label-numberresidents-2"
                  onclick="document.forms['form'].numberresidents.value=this.value;" value="2"> <label data-mlm-field="numberresidents" data-mlm-type="enum" data-mlm-value="2" id="label-numberresidents-2" for="opt-numberresidents_2" class="mc">4 -
                  6</label></div>
              <div class="choicevert"><input type="radio" id="opt-numberresidents_3" tabindex="0" name="numberresidents___radio" aria-labelledby="label-numberresidents label-numberresidents-3"
                  onclick="document.forms['form'].numberresidents.value=this.value;" value="3"> <label data-mlm-field="numberresidents" data-mlm-type="enum" data-mlm-value="3" id="label-numberresidents-3" for="opt-numberresidents_3" class="mc">7 -
                  9</label></div>
              <div class="choicevert"><input type="radio" id="opt-numberresidents_4" tabindex="0" name="numberresidents___radio" aria-labelledby="label-numberresidents label-numberresidents-4"
                  onclick="document.forms['form'].numberresidents.value=this.value;" value="4"> <label data-mlm-field="numberresidents" data-mlm-type="enum" data-mlm-value="4" id="label-numberresidents-4" for="opt-numberresidents_4" class="mc">10 -
                  12</label></div>
              <div class="choicevert"><input type="radio" id="opt-numberresidents_5" tabindex="0" name="numberresidents___radio" aria-labelledby="label-numberresidents label-numberresidents-5"
                  onclick="document.forms['form'].numberresidents.value=this.value;" value="5"> <label data-mlm-field="numberresidents" data-mlm-type="enum" data-mlm-value="5" id="label-numberresidents-5" for="opt-numberresidents_5" class="mc">&gt;
                  12</label></div>
            </span>
            <div data-kind="reset-link" class="resetLinkParent d-print-none">
              <a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('numberresidents','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
            <div id="numberresidents_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
          </td>
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                <div data-mlm-field="facultyappts" data-mlm-type="label"> How many of your PGY1 Pharmacy Residency Preceptors have faculty appointments (non-voluntary or voluntary) at a school of higher learning, such as a pharmacy or medical school?
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(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))
(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))
(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))
(\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
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(\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
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6


NATIONWIDE SURVEY TO CHARACTERIZE THE RESEARCH EXPERIENCES OF ASHP-ACCREDITED
PGY1 PHARMACY RESIDENCY PROGRAMS

A A A 


Please complete the survey below.

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PART 1: DEMOGRAPHICS

Where in the United States is your PGY1 Pharmacy Residency Program located?
(Please see attachment below for states in US Census regions)
* must provide value
Northeast
Midwest
South
West
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Attachment:   1280px-Census_Regions_and_Division_of_the_United_States.svg.png 
(0.22 MB)
What institution type best describes the site of your PGY1 Pharmacy Residency
Program?
* must provide value
Federal government hospital
Academic medical center
Community teaching or nonteaching hospital
Psychiatric or long-term care hospital
Other (Please specify)
reset

Other
* must provide value

How many beds are there at the institutional site of your PGY1 Pharmacy
Residency Program?
* must provide value
< 200
200 - 399
400 - 599
600 - 799
≥ 800
reset

How long has your PGY1 Pharmacy Residency Program been accredited by the
American Society of Health-System Pharmacists?
* must provide value
< 1 year
1 - 5 years
6 - 10 years
11 - 15 years
> 15 years
reset

Is your PGY1 Pharmacy Residency Program affiliated with a school of higher
learning?
* must provide value
Pharmacy School
Medical School
Both Pharmacy and Medical Schools
Not affiliated
Other (Please specify)
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Other
* must provide value

How many residents does your PGY1 Pharmacy Residency Program have?
* must provide value
1 - 3
4 - 6
7 - 9
10 - 12
> 12
reset

How many of your PGY1 Pharmacy Residency Preceptors have faculty appointments
(non-voluntary or voluntary) at a school of higher learning, such as a pharmacy
or medical school?
* must provide value
0
1 - 5
6 - 10
11 - 15
> 15
reset


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