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pdfDEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850
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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 fulfill 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 SurveyModified. 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 and help 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.
DataStat is a survey research organization working with us to carry out this survey. If you have any
problems completing the survey or have other questions about it, please don’t hesitate to call DataStat
toll free at 1-877-455-3387 or e-mail DataStat at [email protected].
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 for you.
CGK02
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MEDICARE HEALTH OUTCOMES SURVEY
MEDICARE HEALTH OUTCOMES SURVEY
Hello!
Hello!
About a week ago you received the Medicare Health Outcomes SurveyModified in the mail.
About a week ago you received the Medicare Health Outcomes SurveyModified 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 your health plan serve you better.
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 your health plan serve you better.
If you have returned the completed questionnaire, thank you!
If you have returned the completed questionnaire, thank you!
If you did not get the questionnaire or have misplaced it, please call
DataStat at 1-877-455-3387 or e-mail DataStat at [email protected]
and we will mail a questionnaire to you.
If you did not get the questionnaire or have misplaced it, please call
DataStat at 1-877-455-3387 or e-mail DataStat at [email protected] and
we will mail a questionnaire to you.
Thank You!
Thank You!
DataStat
CGK03
MEDICARE HEALTH OUTCOMES SURVEY
DataStat
CGK03
MEDICARE HEALTH OUTCOMES SURVEY
Hello!
Hello!
About a week ago you received the Medicare Health Outcomes SurveyModified in the mail.
About a week ago you received the Medicare Health Outcomes SurveyModified 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 your health plan serve you better.
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 your health plan serve you better.
If you have returned the completed questionnaire, thank you!
If you have returned the completed questionnaire, thank you!
If you did not get the questionnaire or have misplaced it, please call
DataStat at 1-877-455-3387 or e-mail DataStat at [email protected] and
we will mail a questionnaire to you.
If you did not get the questionnaire or have misplaced it, please call
DataStat at 1-877-455-3387 or e-mail DataStat at [email protected] and
we will mail a questionnaire to you.
Thank You!
Thank You!
DataStat
CGK03
DataStat
CGK03
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850
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Dear Medicare Beneficiary:
The Centers for Medicare & Medicaid Services (CMS) is conducting a survey of people with
Medicare in managed care plans to learn if the care you receive is keeping you as healthy as possible.
Your name was randomly selected from your health plan.
Recently, we mailed the Medicare Health Outcomes Survey-Modified to you but have not received
your response. We are enclosing another copy and would greatly appreciate your taking the time to
complete the survey. Please return it in the enclosed postage-paid envelope.
Learning about the state of your health is very important to us. While your participation is voluntary,
we hope you will help us by completing the questionnaire. Your answers will have no effect on your
Medicare benefits.
Your answers to the survey will provide information about the state of your health and help 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.
DataStat is a survey research organization working with us to carry out this survey. If you have any
problems completing the survey or have other questions about it, please don’t hesitate to call DataStat
toll free at 1-877-455-3387 or e-mail DataStat at [email protected].
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 for you.
CGK04
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CGK
| File Type | application/pdf |
| File Title | Microsoft Word - E1ST.DOC |
| Author | Administrator |
| File Modified | 2006-06-27 |
| File Created | 2006-04-04 |