Point of Care Patient Questionnaire

PATIENT PHONE CONTACT SCRIPT

Hello,

My name is ________________ and I work for the Salt Lake City VA research department. In the past several weeks we have mailed you several requests to fill out a short survey about a new kind of VA research program. I am calling to remind you to complete that survey if you are willing. You can fill out the survey by going to the internet site on the documents we sent you or we, together, could fill out the survey right now over the phone. Would you be willing to complete the survey? Would you like to do the survey right now with me on the phone or do it yourself on the internet?

<<<< IF THEY AGREE TO DO ON INTERENT >>>

The survey should take 20 minutes of your time and no more than 30. If possible, please complete the survey online within the next couple of days. Here is the internet site again (__________________________) and your code number you will need to enter the survey. Thank you. Your participation is much appreciated.

<<<< END CALL >>>>

<<<< IF THEY AGREE TO DO ON PHONE >>>

The survey should take 20 minutes of your time and no more than 30. I will read the consent cover letter, instructions and then each question. I will record your answers immediately. Please let me know if something is not clear or you could not hear me.

<<< Example question patient might ask: “How did you get my info?” >>>>>

<<<<ANSWER: We received permission to randomly select VA patients from a national registry >>>>

<<< READ THE CONSENT>>>

<<<START INSTRUCTIONS AND QUESTIONNAIRE >>>