From: Subject: Advance Health Care Directive Satisfaction Survey Date: Tue, 20 Oct 2009 13:58:57 -0600 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01CA518D.77FEB420" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01CA518D.77FEB420 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.surveymonkey.com/s.aspx?sm=wukm_2bvB8NpSWJV5Xtzzo6Q_3d_3d =EF=BB=BF Advance Health = Care Directive Satisfaction Survey
Advance Health Care Directive Satisfaction Survey
Exit this survey 
Assessment of the Utah Advance = Health Care=20 Directive Act

The purpose of this research study is to assess=20 professionals' understanding of and satisfaction with Utah=E2=80=99s = Advance Health Care=20 Directive Act and Utah=E2=80=99s Advance Health Care Directive form. =

If you wish=20 to participate, click "next" at the bottom of this page.

This = research=20 study is using an anonymous, on-line survey tool so that participants = cannot be=20 linked to completed surveys, but no procedure is perfect. There is a = small risk=20 that a technical expert could link the author of specific survey to = specific=20 responses; the Commission on Aging will make no effort to link you to = your=20 survey responses. We cannot promise participants any benefits from = participating=20 in this study. It is possible that participants may benefit from = modification to=20 laws or regulations concerning Advance Health Care Directives or forms = that are=20 changed because of what the Commission on Aging learns from the data = collected=20 in this study.

Only anonymous data will be collected. Even if = facts=20 collected or information disclosed by a respondent provides the = researchers with=20 information from which we can identify a survey respondent, we will work = to keep=20 the information confidential. Only the Executive Director of the Utah = Commission=20 on Aging and a law student researcher will have access to the survey = site=20 password to view the collected data. No one associated with the = Commission on=20 Aging or the analysis team will make any attempt to link completed = surveys to=20 survey respondents. Results of the study may be published, but only the = health=20 care setting and/or profession associated with responses will be = disclosed.=20

If you have any questions, concerns, or complaints or if you = feel you=20 have been harmed by this research please contact Maureen Henry, = Executive=20 Director of the Utah Commission on Aging at 801-673-1048. =

Contact the=20 Institutional Review Board (IRB) if you have questions regarding your = rights as=20 a research participant. Also, contact the IRB if you have questions, = complaints=20 or concerns which you do not feel you can discuss with the investigator. = The=20 University of Utah IRB may be reached by phone at (801) 581-3655 or by = e-mail at=20 irb@hsc.utah.edu.

It should take no more than 10 minutes to = complete the=20 questionnaire. Participation in this study is voluntary. You can choose = not to=20 take part and you can also choose not to finish the questionnaire or = omit any=20 question you prefer not to answer without penalty or loss of benefits.=20

By returning this questionnaire, you are giving your consent to=20 participate.

Thank you for your willingness to participate in = this=20 survey.


   


=20 = =20 =20
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