Flyer for Uniform Donor

Attachment 2a: Uniform Donor History Questionnaire Advertisement/flyer – Round 1

Participants Wanted for Research Study

The National Center for Health Statistics is looking for adults

aged 18 years and over, to test questions that are asked about a loved one’s health history. The interview will be no longer than 60 minutes and participants

will receive $40.

FOR MORE INFORMATION,

Please call Liz at: 301-458-4676

Centers for Disease Control and Prevention

National Center for Health Statistics

Attachment 2b: Uniform Donor History Questionnaire Advertisement/flyer – Round 2

Participants Wanted for Research Study

The National Center for Health Statistics

is looking for adults aged 18 years who lost a loved one in the past 12 months to test questions that are asked about the loved one’s health history. The interview will be no longer than 60 minutes and participants

will receive $50.

FOR MORE INFORMATION,

Please call Liz at: 301-458-4676

Centers for Disease Control and Prevention

National Center for Health Statistics

Attachment 2c: Respondents recruited through Procurement Centers – Round 3

For respondents recruited through Procurement Centers: staff would read the following text to the individual, “You may be eligible to participate in a research study [today/on specified date] if you would like to do so. Researchers from the National Center for Health Statistics are evaluating questions used for collecting health history and social information on deceased potential donors of organs and tissues including questions on medical history, sexual history, current medication, and travel history. The interview would take 60 minutes and you would be paid $50.00 for your participation. You are under no obligation to participate in this study. If you are interested in participating in this study or if you would like more information about the study, Dr. Stephanie Willson from the National Center for Health Statistics can meet with you and answer any questions you might have.”

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