Appendix F1 Patient Letter English REV 8.30.10

DRAFT LETTER TO PATIENTS WHO AGREE TO PARTICIPATE IN THE PPHC SURVEY PRINTED ON ONC LETTERHEAD

[DATE]

Dear Patient:

The U.S. Department of Health and Human Services (HHS) would like to learn whether the use of electronic health records improves medical care for patients. HHS has asked Mathematica Policy Research to help conduct this study. We are asking patients about their experiences with and opinions of health care services provided by their primary care providers, who may or may not use electronic records. Your medical practice has agreed to let a Mathematica interviewer speak to patients about the study while they wait to see the doctor.

The study is voluntary, but very important. If you choose to participate, we will ask you to complete a 15-minute survey after your appointment. To thank you for your time we will give you a $10 gift card. All information you provide to us will be kept private to the extent to which law allows and used for research purposes only. We will not ask for your name. We will not share any individual responses outside the research team. We will report only combined responses.

Enclosed is a fact sheet that will give you more information about the study. If you have any questions about the study or your rights as a study participant, please ask the interviewer in the waiting area. You may also contact Karen Bogen, the Mathematica survey director, at 617-674-8355 or by email at [email protected].

Thank you for helping with this important study.

Sincerely,

Privacy Officer

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-NEW and expires XX-XX-20XX. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, 200 Independence Ave. SW, Suite 729-D, Washington, DC 20201.

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