THANK YOU FOR TAKING THIS SURVEY!

An important part of our work is collecting data on the types of patient safety and patient engagement resources that are most useful for patients, family members, caregivers and providers.

Completing the following brief survey will help us obtain data to guide our current patient engagement projects and provide valuable insight for our future efforts.

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* 1. Personal Information (All are optional - your personal information is NEVER shared)

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* 2. Sex of person completing survey

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* 3. Age of person completing the survey

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* 4. May we contact you regarding your survey? If yes, please be sure you have included contact information above.

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* 6. This tool provided useful information to assist me in becoming an informed and engaged patient or patient advocate.

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* 7. I feel that tools, scripts, and other resources help me communicate with my providers.

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* 8. I feel it is important to be prepared in advance for health care visits.

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* 9. I feel that patients and their advocates play an important role in helping to prevent medical errors and improve healthcare safety.

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* 10. I would recommend this resource to my friends and family

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* 11. Which of the following best describes you?

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* 12. I feel comfortable doing the following:

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Planning for my visits in advance
Writing down questions for my provider
Choosing and including an advocate in my care
Asking about the cost of my treatment
Speaking up if I don't understand my treatment
Researching my provider or hospital
Looking up my condition or diagnosis online

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* 13. Narrative - Please use the space below to share any additional information or suggestions.

Thank you for taking this survey! Your time and energy is greatly appreciated and you are an active part of the ongoing efforts to improve our healthcare system.

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