Community Medicine Demographic Survey Question Title * 1. What type of organization do you represent? Private EMS Fire-Based EMS Third City Service Utility Model Other Question Title * 2. Does your organization have a Community Medicine Program? Yes No In the process of starting one Question Title * 3. How long has your Community Medicine Program been active? 0-3 years 3-6 years 6 years or greater Program is no longer active Program is still in planning stage Question Title * 4. What demographic is your Community Medicine Program targeting? Hospital readmission reduction (i.e.CHF or COPD patients) High frequency 911 users Pediatric asthma Hospice Revocation Avoidance Mental Health Nurse Triage Other If you answered other please explain. Question Title * 5. What is the mission of your organizations Community Medicine Program? Our Community Medicine Program does not currently have a mission statement. Please provide mission statement if possible. Question Title * 6. How many full-time personnel are currently assigned to your Community Medicine Program? 0 1-5 5-10 Greater than 10 Question Title * 7. How is your Community Medicine Program funded? City/County State Federal Hospitals Private Insurance Community Grants Other Funding Source Question Title * 8. Who outside your organization has partnered with you in community medicine? We have no external partners at this time. Other Governmental Entities Community Organizations Charitable Organizations Faith Based Organizations Healthcare Organizations Other Type of Organization Question Title * 9. Who evaluates your Community Medicine Program to determine if it has achieved its mission? Chief or Director External Partners City or County Administrators Steering Committee No oversight at this time Question Title * 10. Who would be affected the most if your Community Medicine Program was discontinued? Program is currently in the planning stage Most affected group Done