350 FDA Email Mode 350 FDA Email Model - 8.11.10 FINAL

Model Instance Name:			red & strike-through: DELETE
#REF!			underlined & italicized: RE-ORDER
#REF!			pink: ADDITION
Date:	8.11.2010		blue + -->: REWORDING
#REF!
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
EDO05135		Is the frequency of the FDA email alerts appropriate?	Yes, the frequency is fine		Drop down, select one	Single	Y		Frequency
			I would like to receive it more often.
			I would like to receive it less often.
EDO05136		When would you like to receive email alerts?	During the week business hours only		Drop down, select one	Single	Y		Time
			During the week business and evening hours
			During the week business and evening hours and on weekends
EDO05137		Which of the following best describes your role?	Physician		Radio button, one-up vertical	Single	Y	OPS Group	Role
			Pharmacist/Pharmacy technician
			Nurse/Nurse Practitioner
			Physician Assistant
			Medical resident or fellow
			Medical, pharmacy, nursing, or allied health professional student
			Medical Informatics/librarian in health system setting
			Medical information provider/reporter
			Consumer (not healthcare professional/student)
			Other (please specify)	A
EDO05138	A	Please describe your role:			Text area, no char limit		N	OPS Group	Other Role
EDO05139		Which of the following best describes your primary work setting?	Department of Defense (DOD) or Veteran's Affairs (VA)		Radio button, one-up vertical	Single	Y	OPS Group	Work Environment
			Other government agency
			Private practice; self-employed
			Community-based small group (less than 5 practitioners)
			Multi-specialty group practice, Health Maintenance Organization (HMO)
			Academic medical center
			Community hospital
			Academia
			Pharmaceutical, device, or biological industry
			Retail pharmacy
			Investment firm
			News media
			Other (please specify)	B
EDO05140	B	Please describe your primary work setting:			Text area, no char limit		N	OPS Group	Other Environment
		Please select your level of agreement with the following statements about the MedWatch Safety Alert emails?				Single	Y	Matrix Group
EDO05141		There is an adequate amount of detail provided in the subject line	Agree						Email Details
			Somewhat Agree
			Disagree
EDO05142		The audience identified in the email is accurate (accurately identifies for whom the information is relevant).	Agree						Email Relevance
			Somewhat Agree
			Disagree
EDO05143		The length of the email is appropriate	Agree						Email Length
			Somewhat Agree
			Disagree
EDO05144		There is enough information provided for me to take action on (if necessary)	Agree						Email Info
			Somewhat Agree
			Disagree
EDO05145		The supplemental links provided in the email are useful	Agree						Email Links
			Somewhat Agree
			Disagree
EDO05146		How do you use the MedWatch Safety Alert email information you receive? (Please select all that apply)	To stay current on medical product safety		Radio button, one-up vertical	Multi	Y	OPS Group	Usage
			To inform other colleagues and/or patients
			To present new information at my committee meetings
			To publish the information in professional newsletters
			To add content to my organization's web site
			To update drug information in my organization's electronic formulary or Electronic Medical Record (EMR)
			Other (please specify)	C
EDO05147	C	Please describe how you use the MedWatch Safety Alert email information you receive?			Text area, no char limit		N	OPS Group	Other Usage
EDO05148		On average, with how many individuals in your organization do you share MedWatch Safety Alert emails information with?	Zero		Radio button, one-up vertical	Single	Y		Forward On
			1-5 people
			6-10 people
			11-20 people
			21-50 people
			51-100 people
			101-499 people
			More than 500 people
EDO05149		Which of the following product-specific emails are you interested in receiving? (Please select all that apply)	Drugs and Biologics (Prescription and over-the-counter)		Radio button, one-up vertical	Multi	Y	OPS Group	Product Center
			Medical devices (e.g. stents, implants, radiological products, diagnostics)
			Blood, blood products and tissue
			Vaccines
			Dietary supplements
			Food allergens
			Food-related outbreaks
			Cosmetics
			Other (please specify)	D
EDO05150	D	Please describe the other product specific emails you would like to receive:			Text area, no char limit		N	OPS Group
EDO05151		Which of the following types of information are you interested in receiving? (Please select all that apply)	Emerging safety information about human medical products		Radio button, one-up vertical	Multi	Y	OPS Group	Information Topic
			Labeling changes with associated "Dear Healthcare Professional" letter issued by manufacturer
			Recalls of drugs with a potential for serious injury or death
			Recalls of medical devices with a potential for serious injury or death
			Notices of safety issues related to off label or inappropriate use of drugs or devices
			Safety information about newly approved drugs
			Counterfeit medical products
			Other (please specify)	E
EDO05152	E	Please describe the other types of information you would like to receive:			Text area, no char limit		N	OPS Group
EDO05153		Which of the following audience specific emails would you like to receive? (Please select all that apply)	General health professionals (e.g., Pharmacists, Nurses, Physicians)		Radio button, one-up vertical	Multi		OPS Group	Audience
			Medical specialty audiences (e.g. Urology, Oncology)
			General public
			Other (please specify)	F
EDO05154	F	Please describe the audience you would like to receive emails for:			Text area, no char limit			OPS Group
EDO05155		How else would you like to receive or access MedWatch Safety Alerts or MedWatch information about Monthly Drug Safety Labeling Changes? (Please select all that apply)	Text messages on my mobile phone		Radio button, one-up vertical	Multi		OPS Group
			Audio (i.e. Podcast)
			Video (i.e. YouTube
			Blogs
			Facebook
			Twitter
			MySpace
			GoogleWave
			LinkedIn
			Other (please specify)	G
EDO05156	G	Other ways to access or receive information:			Text area, no char limit
EDO05157		What is the one improvement you would like MedWatch Safety Alerts to make to their emails?			Text area, no char limit				One Improvement