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* 1. Contact Information

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* 2. We accept patients with the following diagnoses: (check all that apply)

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* 3. We admit patients with the following DoC subgroups: (check all that apply)

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* 4. We treat the following age patients with DoC: (check all that apply)

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* 5. We admit and care for international patients with a DoC

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* 6. We admit and care for patients who require mechanical ventilation.

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* 7. We provide the following level(s) of care for patients with DoC: (check all that apply)

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* 8. We provide outpatient/day hospital care for DoC patients.

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* 9. What is the mean length of stay of patients admitted in a DoC? (If more than one program in your center, check all that apply)

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* 10. Length of stay is determined by the following: (check all that apply)

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* 11. How are patients admitted to your center? (check all that apply)

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* 12. Do your providers have specialized training and experience in assessment and management of patients with DoC as defined in the publication: “Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems” (Giacino et al. 2020)?

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* 13. Does your program follow any published DoC guidelines for the diagnosis, prognosis, and/or treatment?

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