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Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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B. MANAGEMENT INFORMATION SYSTEMS (MIS)The following questions are about demographic data your agency may collect on your employedstaff, contractors, and partnership members.1. Please indicate for which <strong>of</strong> the following you keep data on racial and ethnic composition.MARK ALL THAT APPLY~ Employed staff ! go to 2~ Contractors ! go to 2~ Partnership members ! go to 2~ Don’t know ! go to 3~ None <strong>of</strong> the above ! go to 1a1a. To your knowledge, what are the reasons you do not record their race and ethnicity?MARK ALL THAT APPLY~ Privacy rights ! go to 5~ Concerns about quality or completeness <strong>of</strong> data ! go to 5~ Concerns about legal liability ! go to 5~ Other, please specify _______________________________________ ! go to 5~ Don’t know ! go to 52. For which <strong>of</strong> the following do you keep data on racial and ethnic composition <strong>of</strong> your employed staff,contractors, and/or partnership members?EmployedPartnershipMARK ALL THAT APPLY Staff Contractors Membersa. Executive level administrators................. ~ ~ ~b. Supervisors and program managers . ........... ~ ~ ~c. Client services staff ......................... ~ ~ ~d. Accounts/billing staff ........................ ~ ~ ~e. Information specialists....................... ~ ~ ~f. Appointment clerks, receptionists, secretaries, other ~ ~ ~front line personnel ........................g. Physicians ................................ ~ ~ ~h. Dentists .................................. ~ ~ ~i. Physician assistants and nurse practitioners ..... ~ ~ ~j. Nursing pr<strong>of</strong>essionals ....................... ~ ~ ~k. Pharmacy, lab, and X-ray staff ................ ~ ~ ~l. Allied or associated health pr<strong>of</strong>essionals ........ ~ ~ ~m. Interpreters ............................... ~ ~ ~~ Other, please specify _______________________________________~ None <strong>of</strong> the aboveCOSMOS Corporation, December 2003 4

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