Follow-Up Phone Call (One Week Post-Mailing)

Appendix D – Follow-up Phone Call #1 Checklist

P

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx

romotion of the National ALS Registry to

Non-referral Centers: Checklist for Follow-up Call One-week Post-mailing to Neurologists’ Offices

Checklist of points to be covered during each follow-up call to neurologists and neurology practices one week after the mailing:

All practices:

• Identify self, where calling from and project

• Identify name and title of person who answered the phone

• Request to speak with contact person provided during previous call

• Identify name(s) of neurologist(s) within practice

• Confirm if informational packet was received

• If no:

  • Confirm address and fax number

  • Inform caller that a new packet of materials will be faxed within two business days

• If yes, encourage neurologist to hang the poster, read the materials, sign up for the continuing medical education webinar, order additional materials, and distribute the patient brochures, as applicable

• Ask if there are any questions

• Provide our contact information for any questions in the future

• Inform the speaker that we will be calling again in a couple of months about the

material

• Thank speaker for their time

Public reporting burden of this collection of information is estimated to average 3 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 (0923-XXXX).