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What is your primary job function?
1A - Owner, Administrator, Assistant Administrator
1B - Executive Director, Business Manager, Director of Operations
1C - Chief Financial Officer, Chief Purchasing Officer, Multifacility Corporate Officer, Director, Manager
1D - Other Administrative Personnel
1E - Director of Nursing
1F - Assistant DON, Inservice Director, Nursing Supervisor
1G - Certified Nursing Assistant
1H - Consulting Pharmacist
1I - Other Professional
1J - Medical Director, Geriatic Physcian
1Z - Other
Please Specify
What is your type of facility?
2A - Nursing Homes/Extended Care Facilities
2B - Assisted Living/Residential Care Facility
2C - Subacute Care Facility
2D - CCRC
2E - Hospital w/LTC unit
2F - Multifacility Corporate Office
2G - DD Residences
2Z - Other
Please Specify
How many beds do you have at your facility?
3A - 500 or more
3B - 400-499
3C - 300-399
3D - 200-299
3E - 100-199
3F - 50-99
3G - 25-49
3H - 24 or less
3I - None
Please Specify
What is your facility ownership?
4A - Independent For Profit
4B - Independent Non-Profit
4C - Multifacility For Profit
4D - Multifacility Non-Profit
What is your purchasing involvement?
A - Recommend Products Only
B - Serve on Purchasing Committee
C - Specify Products for Purchase
D - Approve Recommendations
E - None of the Above
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IDAHO (ID)
ILLINOIS (IL)
INDIANA (IN)
IOWA (IA)
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KENTUCKY (KY)
LOUISIANA (LA)
MAINE (ME)
MARSHALL ISLANDS (MH)
MARYLAND (MD)
MASSACHUSETTS (MA)
MICHIGAN (MI)
MICRONESIA (FM)
MINNESOTA (MN)
MISSISSIPPI (MS)
MISSOURI (MO)
MONTANA (MT)
NEBRASKA (NE)
NEVADA (NV)
NEW HAMPSHIRE (NH)
NEW JERSEY (NJ)
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Afghanistan
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Andorra
Angola
Anguilla
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Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
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Bahamas
Bahrain
Bangladesh
Barbados
Belarus
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Benin
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Bhutan
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Bulgaria
Burkina Faso
Burundi
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Caribbean Netherlands
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Central African Republic
Chad
Chile
China
Christmas Island
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Colombia
Comoros
Congo
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Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
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Israel
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Mayotte
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Micronesia, Federated States of
Moldova
Monaco
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Montenegro
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Myanmar
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Nauru
Nepal
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New Caledonia
New Zealand
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Niger
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Niue
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North Korea
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Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
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Saint Lucia
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Saint-Martin (France)
Samoa
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ALABAMA (AL)
ALASKA (AK)
AMERICAN SAMOA (AS)
ARIZONA (AZ)
ARKANSAS (AR)
ARMED FORCES AMERICAS (AA)
ARMED FORCES EUROPE (AE)
ARMED FORCES PACIFIC (AP)
CALIFORNIA (CA)
COLORADO (CO)
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DELAWARE (DE)
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GUAM (GU)
HAWAII (HI)
IDAHO (ID)
ILLINOIS (IL)
INDIANA (IN)
IOWA (IA)
KANSAS (KS)
KENTUCKY (KY)
LOUISIANA (LA)
MAINE (ME)
MARSHALL ISLANDS (MH)
MARYLAND (MD)
MASSACHUSETTS (MA)
MICHIGAN (MI)
MICRONESIA (FM)
MINNESOTA (MN)
MISSISSIPPI (MS)
MISSOURI (MO)
MONTANA (MT)
NEBRASKA (NE)
NEVADA (NV)
NEW HAMPSHIRE (NH)
NEW JERSEY (NJ)
NEW MEXICO (NM)
NEW YORK (NY)
NORTH CAROLINA (NC)
NORTH DAKOTA (ND)
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OHIO (OH)
OKLAHOMA (OK)
OREGON (OR)
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PENNSYLVANIA (PA)
PUERTO RICO (PR)
RHODE ISLAND (RI)
SOUTH CAROLINA (SC)
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UTAH (UT)
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BRITISH COLUMBIA (BC)
MANITOBA (MB)
NEW BRUNSWICK (NB)
NEWFOUNDLAND AND LABRADOR (NL)
NORTHWEST TERRITORIES (NT)
NOVA SCOTIA (NS)
NUNAVUT (NU)
ONTARIO (ON)
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