Post Patient Survey-First Mailing [Flesch-Kincaid Reading Level 8.2]
MCO Letterhead
Date
Patient name
Address 1
City State Zip
Dear [Patient’s name]:
The
Centers for Disease Control and Prevention (CDC), [MCO] and Battelle
Centers for Public Health Research are doing research to find out
more about colon cancer testing. Your doctor works in a clinic that
is in this research study. The Centers for Disease Control and
Prevention (CDC) are funding this study.
We
are doing this survey to help CDC find out what people think about
colon cancer tests. The information from this survey will help CDC to
find out why people get tested, and to improve materials about colon
cancer testing for doctors to use with patients.
We
began this study several months ago. We may have sent a similar
survey to you then and you may remember filling it out. Please
complete this new survey even if you did fill out a similar one a few
months ago. Your responses are very important to us.
This
survey has questions about your opinions about colon cancer. It also
has questions about the experiences you might have had talking with
your doctor about colon cancer. Some questions ask about colon cancer
tests you might have had. We would also like to know how you feel
about talking to your doctor about these things.
As
a [MCO] member, you are being asked to fill out a survey about colon
cancer screening about your experiences talking with your primary
care provider about it. We are very interested in your opinions, even
if you have never been screened for colon cancer and even if you
filled out a similar survey in the past. This survey will take
about 30 20 minutes to complete. We have
enclosed $10 in appreciation for your time and effort.
[MCO]
works to give its patients the best health care possible and yoru
taking part in this study will help us do this. The Centers for
Disease Control and Prevention, Battelle Center for Public Health
Research and [MCO] are working together on this study. [HFHS
only-statement regarding participant burden/task]. Please do not
put your name on the survey. Your responses will be private and
will be combined with answers from other people. We will not
identify any person who was in the study in any articles
papers or reports. None of your responses will be shown to
your doctor.
Your
participation in this research study is voluntary. You are free to
choose to complete this survey or not. Your returning this survey
lets us know that your have agreed to participate [HFHS]. You may
receive a reminder to fill it out if you do not return the survey or
a letter telling us you want to opt out. If you are
uncomfortable with any of the questions, you do not have to answer
them. You may refuse to answer any of the questions.
If you do not want to complete the survey, it will not change the
care you receive at [MCO] or coverage through [MCO] and you
may keep the $10. Taking part in this survey does not mean that
you have to take part in future surveys.
HIPPA statement [ABQ HP/Lovelace only]
Please
send your survey in the envelope provided send your completed
survey to Battelle. Please use the stamped and
addressed envelope provided. If you have any questions about
this research study, please call [Battelle contact] at
Battelle, at (206) 528-xxxx or [MCO contact] at [MCO], at
(xxx) xxx-xxxx. If you have questions about your rights as a research
subject, you may call Battelle’s human subject’s
supervisor, Margaret Pennybacker, PhD, at 1-877-810-9530, extension
500. [MCO IRB contact information]. [MCO IRB
rights and responsibility statement].
We
hope you will help us with this important study. Thank you for taking
this survey.
Sincerely,
[Clinic
Mgr or Research Leader
Research staff member] Battelle Centers for Public
Health Research and Evaluation
[Participant opt out statement]
File Type | application/msword |
File Title | Post Patient Survey-First Mailing |
Author | Dvv1 |
Last Modified By | Judith Lee Smith |
File Modified | 2009-08-23 |
File Created | 2009-08-23 |