Your participation is important to ensuring that all voices of the transplant community are heard on this important issue.
Your responses will remain anonymous unless you choose otherwise, and the information you provide will be used to guide advocacy efforts.

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* 1. What is your connection to the person who has had an organ transplant? 

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* 2. What type of organ transplant did the patient have?

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* 3. How many transplants has the patient had?

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* 4. What is the gender identity of the transplant patient? (I/They identify as a) 

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* 5. What is the age of the transplant patient?

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* 6. What is the race of the transplant patient?

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* 7. What best describes the area where the transplant patient lives?

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* 8. What is the patient’s estimated household income currently? 

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* 9. Has the transplant patient received non-invasive (simple blood test) testing to check the status of the organ's health (or potential rejection)? For example, donor-derived cell-free DNA (dd-cfDNA), AlloSure®, Viracor TRAC®, ProsperaTM, or gene expression profiling (GEP), AlloMap, TruGraf.

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* 10. How important do you believe insurance coverage of a routine non-invasive test (simple blood test) has been for checking the health of the transplant patient's organ post-transplant?

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* 11.
What impact would not having insurance coverage for the latest tests to check the health of the organ transplant and rejection have on the transplant patient's life?

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* 12. Please indicate your level of agreement with the following statement: Having to pay out of pocket for non-invasive testing (simple blood test) that checks the health of my transplant would be financially burdensome for me/the patient.

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* 13. Has a blood test, such as dd-cfDNA, or GEP detected any issues with the transplant patient's transplanted organ? For example, donor-derived cell-free DNA (dd-cfDNA), AlloSure®, Viracor TRAC®, ProsperaTM, or gene expression profiling (GEP), AlloMap, TruGraf. 

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* 14. How often does the transplant patient worry about their body rejecting the transplanted organ?

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* 15. Please indicate your level of agreement with the following statement: Transplant patients would prefer a simple blood test over a tissue biopsy to monitor the health of the transplanted organ.

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* 16. Please indicate your level agreement with the following statement: Invasive biopsies have impacted my quality of life, or otherwise been burdensome to me.

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* 17. Please indicate your level of agreement with the following statement: Reduced insurance coverage for a simple blood test that checks the health of the transplant would impact transplant patient's post-transplant care in a negative way.

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* 18. How aware are you of a new Medicare Billing Article addressing the reimbursement and coverage of non-invasive testing (simple blood test) for Medicare patients?

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* 19. Are you concerned that the Billing Article limits coverage of non-invasive testing (simple blood test) and, with it, physicians' options to provide the best care for transplant patients? 

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* 20. Please indicate your level of agreement with the following statement: Medicare should cover non-invasive testing (simple blood test) on an ongoing surveillance (monitoring) basis to check the health of the transplanted organ on a regular basis.

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* 21. Please indicate your level of agreement with the following statement: Patients should be consulted as part of the process for determining new or making changes in Medicare coverage policies.

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* 22. Is there anything else you would like to share about post-transplant non-invasive (simple blood test) testing, biopsies, or monitoring the health of the transplanted organ?

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* 23. To what extent are you willing to get involved and advocate for coverage of non-invasive (simple blood test) testing? Check all that apply. 

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* 24. Can we contact you in the future about opportunities to get involved and advocate for insurance coverage to non-invasive testing (simple blood test)? 

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* 25. First Name (optional)

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* 26. Last Name (optional)

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* 27. Email Address (optional)

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* 28. Phone Number (optional)

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* 29. State of Residence (optional)

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