Form OMB 0917-0036-0031 OMB 0917-0036-0031 OMB 0917-0036-0031, EHR Pharmacy Resident Informaticist

REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) Post Class Survey 

Form Approved 
OMB Form No. 0917­0036­31 
Expiration Date: 5/31/2015 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information 
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0917­0036. 
The time required to complete this information collection is estimated to average 5 minutes per response, including the 
time to review instructions, search existing data resources, gather the data needed, and complete and review the 
information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for 
improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence 
Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer. 

*1. Rate your knowledge of the Resource and Patient Management System (RPMS)

Pharmacy package prior to starting this rotation:
c None
d
e
f
g

c Minimial Use
d
e
f
g

c Moderate Use
d
e
f
g

c Other (please describe)
d
e
f
g

c High End User
d
e
f
g

*2. Rate your experience with RPMS Pharmacy Package TODAY:
c None
d
e
f
g

c Minimial Use
d
e
f
g

c Moderate Use
d
e
f
g

c Other (please describe)
d
e
f
g

c High End User
d
e
f
g

*3. Rate your experience with RPMS/Electronic Health Record (EHR) prior to this

rotation:
c None
d
e
f
g

c Minimial Use
d
e
f
g

c Moderate Use
d
e
f
g

c Other (please describe)
d
e
f
g

c High End User
d
e
f
g

*4. Rate your experience with RPMS/EHR TODAY:
c None
d
e
f
g

c Minimial Use
d
e
f
g

c Moderate Use
d
e
f
g

c Other (please describe)
d
e
f
g

c High End User
d
e
f
g

*5. Did you find that the homework assignments for each month were helpful and

appropriate?

j Yes
k
l
m
n
j No
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n

If no, please explain  

*6. List 3­5 topics that you have learned over the rotation that benefit you and your site:
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*7. List any topic that did NOT benefit you or your site:
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*8. Suggested topics not on the syllabus:
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*9. Suggestions for improvement to the rotation:
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Please check a box to rate each of the statements listed below: 

*10. Please describe the quality of the presentation materials and methods used in this

training.

Materials were clearly 

Poor

Fair

Good

Very Good

Excellent

N/A

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written and easy to 
understand
Training was paced 
appropriately
Sufficient time for 
comments and audience 
interaction was provided
Comments (please specify) 

*11. Please enter date of session you attended:

12. Closing comments, suggestions, and ideas:
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