Medical Resource Dissemination

Medical Resource Evaluation
Form Approved, OMB No. 0920-XXXX Exp. Date XX/XX/20XX
This survey is in reference to the material/s you received from the Tourette Syndrome Association. The resources were
developed through a partnership with the U.S. Centers for Disease Control and Prevention. Survey results will help us to
assess the impact of the materials on your knowledge and patient care and better focus our outreach efforts. Thank you
for your time.
Public reporting burden of this collection of information is estimated to average 2 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/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D- 74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX).

1. Please indicate your profession.
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Physician

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n

Nurse Practitioner

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n

Social Worker

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n

Physician Assistant

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n

Ph.D.

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n

Counselor

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n

Nurse

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Psychologist

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Occupational Therapist

Other (please specify)

2. Which medical resource did you use?
6
Other (please specify)

3. Do you have experience in managing patients with TS?
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Yes

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No

Comment:

4. Please rate your knowledge related to the following areas before and after using this
resource.
Knowledge Before

Knowledge After

Diagnosis/Recognition of TS

6

6

Co-occurring conditions

6

6

Treatment options

6

6

Patient/Family Education

6

6

Medical Resource Evaluation
5. Do you think that your skills in recognizing/diagnosing TS have improved, as a result
of using this resource?
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Yes

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No

Comment:

6. Do you think that your skills in managing TS have improved, as a result of using the
resource?
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Yes

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No

Comment:

7. Have you integrated the information learned into patient care?
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g

Yes

c
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g

No

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N/A at this time

If yes, please describe:

8. Have you applied the knowledge gained as a result of using the resource?
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Yes

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No

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N/A at this time

Comment:

9. Please rate the usefulness of the resource to your current practice.
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Very useful

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f
g

Useful

c
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f
g

Somewhat useful

c
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f
g

Not at all useful