Usage Survey: Understanding Health & Health Promotion for People with ID

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* 1. Please indicate the number of the case(s) you are commenting on: (Select all that apply.)

Case 1: Mr. Herman Cruz, a 57 year old man who has diabetes and is obese, visiting a new primary care provider

Case 2: Ms. Terry Schaeffer, a 35 year old woman, on a visit with a new primary care provide

Case 3: Mr. James Foster, a 22 year old man visiting the emergency department because of a severe cough

Case 4: Ms. Grace Tester, a 63 year old woman with dementia and breast cancer

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* 2. Are you a: (Check one.)

LEND or UCEDD Trainee

LEND or UCEDD Staff or faculty

Other (please explain)

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* 3. Did you learn new information from the Case?

Yes

Comments:

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* 4. How likely are you to incorporate information from this Case into your own work?

Very likely

Likely

Somewhat likely

Not very likely

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* 5. How strongly do you agree or disagree with the following statements? The information in the Case is...

	Strongly Agree	Agree	Disagree	Strongly Disagree
Useful?	Useful? Strongly Agree	Useful? Agree	Useful? Disagree	Useful? Strongly Disagree
Relevant to your needs?	Relevant to your needs? Strongly Agree	Relevant to your needs? Agree	Relevant to your needs? Disagree	Relevant to your needs? Strongly Disagree

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* 6. Overall, how satisfied are you with the Case?

1 Extremely Dissatisfied

2 Dissatisfied

3 Satisfied

4 Extremely Satisfied

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* 7. How did you hear about the Module: Understanding Health and Health Promotion for People with ID?

It was assigned by my LEND or UCEDD Program

It was not an assignment but I heard about it from LEND or UCEDD staff

Colleague

Webinar

Professional Newsletter

Conference

Other (please explain)

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* 1. Please indicate the number of the case(s) you are commenting on: (Select all that apply.)

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* 2. Are you a: (Check one.)

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* 3. Did you learn new information from the Case?

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* 4. How likely are you to incorporate information from this Case into your own work?

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* 5. How strongly do you agree or disagree with the following statements? The information in the Case is...

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* 6. Overall, how satisfied are you with the Case?

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* 7. How did you hear about the Module: Understanding Health and Health Promotion for People with ID?

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* 8. Please provide any other feedback that will help us improve the Case(s).