PPC Registration Form
Practice Address
How many staff members are in your practice? If you works at a group-based clinic or large facility (eg., medical school or hospital), please provide the staffing numbers in your workgroup.
How comfortable are you at each stage within the continuum of mental/behavioral health medication management? Note: One of the goals of this program is to increase your comfort with management of non-complicated diagnoses without additional comorbidities. Your Regional Hub is always available to support you with patient care management. *
Not comfortable at all (prefer not to do this for all or only the easiest handful of cases)
Comfortable with some cases (5-33% of behavioral cases)
Generally Comfortable (33-66% of behavioral cases)
Very Comfortable (66-95+% of behavioral cases)
Extremely Comfortable (comfortable with all but the most difficult handful of cases)
Identifying a mental/behavioral health diagnosis
Initiating/prescribing medication
Titrating to therapeutic dose
Monitoring for side effects
Tapering off
Following up with the family/patient
Providing additional resources and support
How did you hear about the New Jersey Pediatric Psychiatry Collaborative? (Check all that apply)
What Racial/Ethnic group do you identify with?
What language(s) do you and does your practice team speak? Check all that apply.