Chinese Mailing Material

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Walter Stone
CMS Privacy Officer

ENGLISH ON THE OTHER SIDE
LETTER 1 (CCHP) - 2006 HOS

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Dear Medicare Beneficiary:
The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that administers the Medicare
program. Our responsibility is to make sure that you get high quality care. One of the ways we can fulfil that
responsibility is to find out directly from you about how the care you are currently receiving under the Medicare
program affects your health.
CMS is conducting a survey of people with Medicare called the Medicare Health Outcomes Survey. Your name
was selected at random by CMS from among the people in your health plan with Medicare. We would greatly
appreciate your taking the time to fill out this questionnaire. A postage-paid return envelope is enclosed.
Your answers to the survey will provide information about the state of your health. You will be contacted 2
years from now and asked to complete the survey again. Your answers to the two surveys will be compared to
determine if the care you receive is keeping you as healthy as possible. After the study is completed, your
responses will be shared with your health plan. Your plan will use this information to improve the quality of care.
Learning about the state of your health is very important to us. While your participation is voluntary, we hope
that you will take the time to answer the questionnaire. Your answers will have no effect on your Medicare
benefits.
National Research Corporation is a survey research organization working with us to carry out this survey. If you
have any problems completing the survey or would like to receive an English copy of the questionnaire, please
contact National Research Corporation toll free at 1-877-885-2442 or e-mail National Research Corporation at
hos@nationalresearch.com.
Thank you for your help with this important survey.
Sincerely,

Walter Stone
CMS Privacy Officer

P.S. If you have trouble completing the survey, a relative, friend or caregiver, who knows about your health, can
fill out the survey about you.

LETTER 1 (CCHP) - 2006 HOS

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Walter Stone
CMS Privacy Officer

National Research Corporation is a survey research organization working with us to carry out this
survey. If you would like to receive an English copy of the questionnaire, please contact National
Research Corporation toll free at 1-877-885-2442 or e-mail National Research Corporation at
hos@nationalresearch.com.
LETTER 2 (CCHP) -2006 HOS

MEDICARE HEALTH OUTCOMES SURVEY
Health Outcomes Survey

415-397-0776,

256

Hello!
About a week ago you received the Medicare Health Outcomes Survey in the mail. This is a reminder that
we would like you to fill out the questionnaire and mail it back in the postage paid envelope that came with it. We
need your answers. This is your chance to help serve you better.
If you have returned the completed questionnaire, thank you!
If you did not get the questionnaire or would like to receive an English copy of the questionnaire, please contact
National Research Corporation toll free at 1-877-885-2442 or e-mail at hos@nationalresearch.com and they
will mail a questionnaire to you.

Please
Stamp
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CCHP PostCard2006 HOS