Contact Protocol for Control (Patient) Participants

Att 7c_Contact protocol_control participants.docx

Using Real-time Prescription and Insurance Claims Data to Support the HIV Care Continuum

Contact Protocol for Control (Patient) Participants

OMB: 0920-1361

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Attachment 7c

Contact protocol – control participants



Eligible potential participant information


Name:

DOB:

ID:

Phone:


Other information


Contact attempt number:

Scheduled call (yes/no):

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Notes (pre-call)





Optional Expand

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D ate and time of call

* must provide value Click "today" when you start the call


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Now

Click "now" when you start the call


No Answer


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Did anyone answer the phone? Yes

* must provide value No



Leave a voicemail.



Hello, it's [Linkage Coordinator’s name] I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care organization] members. I’d like to tell you more about it. Could you call me at [Linkage Coordinator’s phone number]? I’m available [Linkage Coordinator’s working hours]. Thanks!


End time of call

* must provide value official

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Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand




Wrong Number


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. May I speak with [potential participant’s name]?

* must provide value


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Yes

No: not available, number correct

No: suspected wrong number



Phone # confirmed



Can you confirm that this is [potential participant’s phone number]?

* must provide value


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Confirmed

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Not confirmed




I’m sorry, I must have the wrong phone number. Thank you.



End call.





Phone # not confirmed



Can you confirm that this is [potential participant’s phone number]?

* must provide value


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Confirmed

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Not confirmed




I’m sorry, I must have the wrong phone number. Thank you.



End call. Re-attempt with correct phone number. Reset the call start time.


End call



End time of call

* must provide value

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Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand



Did Not Reach / Not Available


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. May I speak with [potential participant’s first name]?

* must provide value


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Yes

No: not available, number correct

No: suspected wrong number




Thank you. It’s [Linkage Coordinator’s name] calling. I’ll call back another time.



End call.


End time of call

* must provide value

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Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand






Incorrect Name and/or DOB


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. May I speak with [potential participant’s first name]?

* must provide value


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Yes

No: not available, number correct

No: suspected wrong number



Thank you. I’m calling to talk to you about a study for eligible Virginia Medicaid members. Virginia Medicaid strives to improve your quality of care. This involves evaluating how to promote your health. In the past week, you should have received information about a study in the mail.


The study is about something that may be confidential.


I want to make sure that I am talking to the right person. I can do this by confirming your identity. I want to do this to protect your privacy.




The letter that we sent you has an ID number on it. One way that I can confirm your identity is using this ID number.


Do you mind telling me the ID number on the letter?



Participant has correct ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant has incorrect ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant does not have any ID number (e.g., no letter): That’s ok. We can use different information. Do you mind telling me your first and last name and date of birth?



Expected ID number:

Expected name:

Expected DOB:




Did the participant verify their name and DOB?

* must provide value


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Yes: name and DOB verified

No: incorrect name and/or DOB

No: will not verify name and/or DOB



Phone # confirmed



Can you confirm this is [potential participant’s phone number}?

* must provide value


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Confirmed

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Not confirmed



I’m sorry, I must have the wrong phone number. Thank you.


End call.





Phone # not confirmed



Can you confirm this is [potential participant’s phone number}?

* must provide value


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Confirmed

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Not confirmed



I’m sorry, I must have the wrong phone number. Thank you.


End call. Re-attempt with correct phone number. Reset the call start time.


End call



End time of call

* must provide value

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Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand





Will Not Verify Name and/or DOB


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. May I speak with [potential participant’s first name]?

* must provide value


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Yes

No: not available, number correct

No: suspected wrong number



Thank you. As I said before, I’m calling to talk to you about a study for eligible Virginia Medicaid members. Virginia Medicaid strives to improve your quality of care. This involves evaluating how to promote your health. In the past week, you should have received information about a study in the mail.


The study is about something that may be confidential.


I want to make sure that I am talking to the right person. I can do this by confirming your identity. I want to do this to protect your privacy.


The letter that we sent you has an ID number on it. One way that I can confirm your identity is using this ID number.


Do you mind telling me the ID number on the letter?



Participant states correct ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant states incorrect ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant does not have any ID number (e.g., no letter): That’s ok. We can use different information. Do you mind telling me your first and last name and date of birth?



Expected ID number:

Expected name:

Expected DOB:




Did the participant verify their name and DOB?

* must provide value

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Yes: name and DOB verified

No: incorrect name and/or DOB

No: will not verify name and/or DOB











Send certified letter



I understand, and I appreciate your time today. You might like more information later. Could I send you a certified letter to describe the study?

* must provide value


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Yes: certified letter

No: no certified letter



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Great. Do you mind providing your mailing address?


Optional Expand




Thank you. I appreciate that you’re willing to learn more. I’ll send a certified letter to [state mailing address].


I’ll call you back to follow-up within a week. In the meantime, you can call me at [Linkage Coordinator’s phone number} with any questions. I look forward to talking again soon.


End call.



Do not send certified letter



I understand, and I appreciate your time today. You might like more information later. Could I send you a certified letter to describe this study?

* must provide value

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Yes: Certified letter

No: No certified letter


I understand. Thank you for your time. If you change your mind, you can call me at [Linkage Coordinator’s phone number}.

End call.



End Call



End time of call

* must provide value

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Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand





Personal Information Verified – Not Available to Talk Now


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. May I speak with [potential participant’s first name]?

* must provide value


Shape38

Yes

No: not available, number correct

No: suspected wrong number



Thank you. As I said before, I’m calling about a study for eligible Virginia Medicaid members. Virginia Medicaid strives to improve your quality of care. This involves evaluating how to promote your health. In the past week, you should have received information about a study in the mail.


The study is about something that may be confidential. I want to make sure that I am talking to the right person. I can do this by confirming your identity. I want to do this to protect your privacy.


The letter that we sent you has an ID number on it. One way that I can confirm your identity is using this ID number.


Do you mind telling me the ID number on the letter?



Participant has correct ID number: Great. Do you mind telling tell me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant has incorrect ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant does not have any ID number (e.g., no letter): That’s ok. We can use different information. Do you mind telling me your first and last name and date of birth?



Expected ID number:

Expected name:

Expected DOB:




Did the participant verify their name and DOB?

* must provide value


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Yes: name and DOB verified

No: incorrect name and/or DOB

No: will not verify name and/or DOB



Thank you. Do you prefer [potential participant’s first name] or do you go by another name?

* must provide value


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Prefer [potential participant’s first name]

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Prefer another name






Preferred name

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Thanks, [potential participant’s preferred first name].


As I said, my name is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. The study is about something that may be confidential. Can you talk about something that may be confidential right now?


* must provide value



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Yes

No



Alternative call time identified



I understand. It would be great to talk with you more about this study. Could we talk about the study a different time?


* must provide value


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Yes

No


Great! What is a good day and time for you to discuss?




Schedule alternative call: date.


* must provide value

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Click to identify day for alternative call.




Schedule alternative call: time.


* must provide value

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H:M

Click to schedule time for alternative call.




Thank you. I appreciate your time and will call you back at [potential participant’s phone number] on [scheduled date] at [scheduled time]. In the meantime, you can call me back at [Linkage Coordinator’s phone number] if you have questions or need to reschedule.


End call.





Alternative call time not identified



I understand. It would be great to talk with you more about this study. Could we talk about the study a different time?


* must provide value












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Yes

No



I understand. I will try calling you again a different time. In the meantime, you can call me at [Linkage Coordinator’s phone number] during [Linkage Coordinator’s working hours], if you have questions.

Thank you. I look forward to talking to you a different time.


End call.




End Call



End time of call

* must provide value

Shape48

Now H:M

Click "now" when you end the call



Notes (post-call)

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Expand









Personal Information Verified – Available to Talk


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Did anyone answer the phone? Yes

* must provide value No



Hello, this is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care organization] members. May I speak with [potential participant’s name]?

* must provide value


Shape51

Yes

No: not available, number correct

No: suspected wrong number



Thank you. As I said, I’m calling to talk to you about a study for eligible Virginia Medicaid members. Virginia Medicaid strives to improve your quality of care. This involves evaluating how to promote your health. In the past week, you should have received information about a study in the mail.


The study is about something that may be confidential.


I want to make sure that I am talking to the right person. I can do this by confirming your identity. I want to do this to protect your privacy.





The letter that we sent you has an ID number on it. One way that I can confirm your identity is using this ID number.


Do you mind telling me the ID number on the letter?



Participant has correct ID number: Great. Do you mind telling tell me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant has incorrect ID number: Great. Do you mind telling me your first and last name and date of birth? This is all I will need to confirm your identity.



Participant does not have any ID number (e.g., no letter): That’s ok. We can use different information. Do you mind telling me your first and last name and date of birth?



Expected ID number:

Expected name:

Expected DOB:




Did the participant verify their name and DOB?

* must provide value


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Yes: name and DOB verified

No: incorrect name and/or DOB

No: refusal to verify name and/or DOB



Did the participant verify their name and DOB?

* must provide value


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Yes: name and DOB verified

No: incorrect name and/or DOB

No: refusal to verify name and/or DOB



Thank you. Do you prefer [potential participant’s first name] or do you go by another name?

* must provide value


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Prefer [potential participant’s first name]

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Prefer another name




Preferred name

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Thanks, [potential participant’s preferred name].


As I said, my name is [Linkage Coordinator’s name]. I’m calling on behalf of Virginia Medicaid about a quality improvement study for Medicaid and [name of member’s Medicaid Care Organization] members. The study is about something that may be confidential. Can you talk about something that may be confidential right now?


* must provide value


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Yes

No


Go to Verbal consent – control participants form




Notes (post-call)

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorApril Kimmel
File Modified0000-00-00
File Created2021-10-20

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