Cover Letter First Mailing

Sample Cover Letter for First Questionnaire Mailing
Medical Home Survey
NAME
ADDRESS
CITY, STATE ZIP

[PRINT SAMPLE IDENTIFICATION NUMBER HERE]

Dear NAME:
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs the
Medicare program and helps to ensure that you get high quality care. CMS has contracted with
non-profit research company RTI International to conduct a survey to learn more about the
health care services you receive at [PRACTICE NAME]. Your name was selected at random by
CMS from among Medicare beneficiaries who receive care at [PRACTICE NAME].
We would greatly appreciate it if you would take about 20 minutes to fill out the survey. The
results of this survey will be used to improve the quality of services that Medicare beneficiaries
like you receive.
All information that would let someone identify you or your family will be kept private. RTI
International will not share your personal information with anyone. Your responses to this survey
are also completely confidential. Your individual answers will never be seen by your provider or
anyone else involved with your care. You may notice a number on the cover of the survey. This
number is used only to let us know if you returned your survey so we don’t have to send you
reminders.
You may choose to answer this survey or not. Your decision will not affect the health care you
get. Once you complete the survey, place it in the return envelope that was provided, seal the
envelope, and mail the envelope to RTI International.
If you have any questions about this survey, please call [NAME] toll free at [RTI Toll-free
number]. If you have any questions about your rights as a survey respondent, you may call RTI's
Office of Research Protection toll-free at 1-866-214-2043.
Thank you in advance for your participation.
Sincerely,
[Signature]
Nancy McCall, RN, Sc.D.
MAPCP Project Director
RTI International
Nota: Si quiere una encuesta en español, por favor llame al (XXX) [XXX-XXXX].
Enclosures