Attachment E Informed consent 2019-03-11

Attachment E Informed Consent 2019-03-11.docx

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

Attachment E Informed consent 2019-03-11.docx

OMB: 0935-0124

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Attachment E

Informed Consent Form

Child HCAHPS Narrative Elicitation Pilot Test



You are invited to be part of a group of Knowledge Networks Panel Members in a study being conducted by Yale University, the University of Wisconsin and RAND, a non-profit research organization based in California. This study is funded by the Agency for Healthcare Research and Quality (AHRQ), an agency within the federal Department of Health and Human Services. The purpose of this study is to learn about parents’ experiences with hospitals where their children have received care. Your participation in this study will involve responding to some questions about your recent visits to your health care provider. Completing this survey will take about 15 minutes.

A small number of survey participants will be randomly selected for more detailed interviews about their health care experiences. These follow-on interviews will be conducted by phone and will last about an hour.

Your participation in this study is completely voluntary. You may participate in the initial survey about your health care experiences without any obligation to agree to a follow-on interview; at the end of the survey, we will ask if you are willing to be contacted for the phone interview. You may withdraw your consent, discontinue participation, and/or refuse to answer any questions at any time without penalty. As always, your identity will be kept confidential in all data and reports resulting from the study. Furthermore, the information collected through this study will only be reported in the aggregate – no particular person’s responses will be singled out.

There is no identifiable risk to you from participating in this study. Participation in this survey will not affect the care that your children receive. The main benefit to participating in this study is that you will contribute to general understanding about how people use information to make health care decisions.

All of the conditions and terms described in the "Knowledge Networks, Inc. Privacy & Terms of Use Policy" document that you received when you got your recruitment packet are in effect for this study. If you have questions about your rights as a participant in this study, or about any other aspect of this study, you may contact Knowledge Networks at (800) 782-6899.

Would you like to participate in this study? If yes, the survey will follow.


Yes

No



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