WPHSS – English Screen Shots
Opening Screen
OMB #0920-xxxx
Exp. Date xx-xx-20xx
Screener Questions:
If ineligible:
If eligible:
Consent Script:
If decline to participate in the survey:
If they agree to participate in the survey, contact information:
Demographics
Health Insurance Status
Enrollment Patterns:
Preventive Care Access:
Participation in Screening:
Health Outcomes:
| File Type | application/pdf |
| Author | Stephanie Poland |
| File Modified | 2017-02-06 |
| File Created | 2017-01-26 |