Registration for STEPS: HIV, HCV, and Syphilis Recorded Presentations

Registration to access Online Videos and Resources from STEPS programming.

By registering you are being provided access to all STEPS recorded presentations.

We appreciate knowing more about you and your practice for registration records, reporting aggregate patterns to funders, and identifying educational needs for programming design, scholarship and evaluation.

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* 1. First Name

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* 2. Last Name

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* 3. Email address

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* 4. Organization

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* 5. Which city/town do you reside?

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* 6. Province

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* 7. What is your profession?

Specialty Physician

Family Physician

Medical Resident

Medical Student

Nurse Practitioner

Registered Nurse

Pharmacist

Other (please specify)

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* 8. In the last 12 months, how many people living with each STBBI have you provided care to? Note: This info is being collected to assist with program design and delivery. Your response is voluntary, kept confidential, and used anonymously.

	Zero	1-5	5-10	10-20	20-30	30-40	40+
HIV	HIV Zero	HIV 1-5	HIV 5-10	HIV 10-20	HIV 20-30	HIV 30-40	HIV 40+
HCV	HCV Zero	HCV 1-5	HCV 5-10	HCV 10-20	HCV 20-30	HCV 30-40	HCV 40+
Syphilis	Syphilis Zero	Syphilis 1-5	Syphilis 5-10	Syphilis 10-20	Syphilis 20-30	Syphilis 30-40	Syphilis 40+

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* 9. Which statement BEST describes your current HIV clinical practice? Note: This info is being collected to assist with program design and delivery. Your response is voluntary, kept confidential, and used anonymously.

Not applicable – I do not provide clinical care to patients in my profession.

I am providing primary care to people living with HIV and primarily managing their ARV medication treatment. When needed, I refer patients to an HIV specialist.

I am providing primary care to people living with HIV. I refer all patients to an HIV specialist for ARV medication treatment.

I do not yet feel confident treating or providing primary care to people living with HIV. I am referring all patients to an HIV specialist.

I am a medical resident interested in treating HIV in the future.

I provide support (case management, outreach, etc.) to people living with HIV.

Other (please specify)

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* 10. Which statement BEST describes your current Hep C clinical practice? Note: This info is being collected to assist with program design and delivery. Your response is voluntary, kept confidential, and used anonymously.

Not applicable – I do not provide clinical care to patients in my profession

I am treating HCV in my clinic setting. When needed, I refer patients to an HCV specialist.

I do not yet feel confident treating HCV. I am referring all patients to an HCV specialist.

I am a medical resident interested in treating HCV in the future.

Other (please specify)

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* 11. Which statement BEST describes your current syphilis clinical practice? Note: This info is being collected to assist with program design and delivery. Your response is voluntary, kept confidential, and used anonymously.

Not applicable – I do not provide clinical care to patients in my profession

I am treating syphilis in my clinical setting.

I do not yet feel confident treating syphilis. I am referring all patients to public health and/or a specialist.

Other (please specify)

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* 12. Additional comments:

Thank you for providing the above information, please copy and paste into a text document to save your access this link and password. It will also appear on the final thank you screen: www.steps-sk.ca/portal Password: STEPS_SK
If there is issues access try https://rise.articulate.com/share/EIMwyEgLD02LQcpgFnPrVPnmzZacQqbX