Clinic Staff Script - Approaching Clients

Attachment 7d

Clinic Staff - Approaching Clients

Form Approved:

OMB No. 0920-new

Expiration Date: XX/XX/XXXX

SciMetrika Health Survey

In Coordination with CDC and the local Health Department

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC, Project Clearance Officer, 1600 Clifton Road, MSD-74, Atlanta, GA 30333, ATTN: OMB PRA (0920-XXXX). Do not send the completed form to this address

Clinic Staff – Approaching Clients

APPROACH USED BY CLINIC STAFF WITH POTENTIAL PARTICIPANTS DURING CHECK-IN, TRIAGE, AND/OR DURING THE CLIENT’S CLINIC APPOINTMENT:

Have you heard about the new health survey being conducted by the CDC and the Health Department? They are administering surveys to people in local clinics to better understand issues related to people’s health, their health behaviors, and how HIV may affect them. 

Here is an information sheet on the project. The sheet will give you more details about the survey and what would be involved. If you choose to participate and are eligible, all of your answers would be kept secure to the extent permitted by law and not shared with us or anyone else. It would not interfere in any way with your patient care activities here. Also, they are not trying to sell anything. They just want to learn about health behaviors of people accessing care in clinics. 

If you decide you are interested, you can contact the person listed in the information sheet. They can answer any questions you may have.

Clinic Staff – Approaching Clients Page 2