Translation Rater Form Question Title * 1. Evaluator Information: First Name: Last Name: Question Title * 2. Language Arabic Burmese Korean Portuguese Simplified Chinese Somali Spanish Tagalog Traditional Chinese Vietnamese Question Title * 3. Date of Review: Select today's date below. Date II. EVALUATION Completely Disagree = 1 Do Not Agree = 2 Neutral = 3 Agree = 4 Completely Agree = 5 Question Title * 4. Please rate the translated PRAPARE tool for the following areas: Score (1-5) The translation is accurate. 1 2 3 4 5 The translation is accurate. Score (1-5) menu The translation is culturally appropriate. 1 2 3 4 5 The translation is culturally appropriate. Score (1-5) menu The translation is easy to understand. 1 2 3 4 5 The translation is easy to understand. Score (1-5) menu Comments: Question Title * 5. If you had a chance to test the translation with patients, please rate the following from your patient perspective. Please rate the translated PRAPARE tool for the following areas: Score (1-5) From the patient perspective, the translation is accurate. 1 2 3 4 5 From the patient perspective, the translation is accurate. Score (1-5) menu From the patient perspective, the translation is culturally appropriate. 1 2 3 4 5 From the patient perspective, the translation is culturally appropriate. Score (1-5) menu From the patient perspective, the translation is easy to understand. 1 2 3 4 5 From the patient perspective, the translation is easy to understand. Score (1-5) menu Comments: Question Title * 6. Is there anything else you would like to share regarding the translation? Question Title * 7. Would you be willing to be contacted should the PRAPARE team have follow-up questions based on your responses? Yes No Question Title * 8. If you responded Yes to the question above, please provide your contact information below. Email of person completing this form: Position/Title of person completing this form: Organization: City: State: Done
