ࡱ> 130q r bjbjt+t+ " AAd ]80 < 4| |  q q q H$q m q q q   | q .  q  2 #:, p 0S_Ƭ R Survey of Users of the Kidney Disease Quality of Life Questionnaire (KDQOL() Dear Kidney Disease Treatment Provider or Researcher: According to our records, you requested a copy of the KDQOL( from us. We are very interested in hearing about your experiences. Please answer the following brief set of questions and return this survey to us at RAND within 14 days. Thank you in advance, The Kidney Disease Quality of Life (KDQOL() Working Group RAND 1776 Main Street Santa Monica, CA 90407 (310) 393-0411 1. Please describe your institution, including the number of patients you treat and the type of facility:  2. Have you administered the KDQOL( to your kidney disease patients? [ ] YES [ ] NO -> If you have not administered the KDQOL( to any patients, please stop here and return the survey. 3. About how many patients have you administered the KDQOL( to thus far? _____ patients 4. Why are you using the KDQOL( (i.e., for what purpose)?  5. Please describe any problems youve experience in administering, scoring, or interpreting the KDQOL(: 6. What support materials would you like to help you use the KDQOLTM?  7. What other comments do you have about the KDQOL(?  8. Are you willing to include data you have collected in a normative database maintained by the KDQOL( Working Group? [ ] YES [ ] NO Please provide your name, address and phone number below (including email address if available) so we have current contact information about you.  THANK YOU FOR COMPLETING THIS SURVEY. PLEASE RETURN IT IN THE PREPAID RETURN ENVELOPE TO: Karen Spritzer UCLA School of Medicine Division of General Internal Medicine & Health Services Research 911 Broxton Plaza, Room 222 Box 951736 Los Angeles, CA 90095-1736 Fax: 310-794-0732 Email: KSpritzer@mednet.ucla.edu Voice: 310-794-0729  PAGE 4 JKLN{|EFQRB C f d e k l m n q r 0JmH0J j0JU6H*5CJ  j#MNOPQ  uv $$$"$$l$$$MNOPQ  uv uvwxyz>HIJKLMNOPQRS ` o         f g v   / P d l m p q r  $ ^ uvwxyz>w@Pz%$$l t$"  %$$l t$" $ P v|$ HIJKx%$$l t$:# P%$$l t$"  %$$l t$" $P KLMNOPQR~xz%$$l t$:# P%$$l t$:# $%$$l t$:#   S ` o       Pz%$$l t$:#  %$$l t$:# $P   f g v   / P d o p q r   $z$%$$l t$:#   P/ =!"#p$p%. [6@6 Normal7$8$_HmH sH tH <A@< Default Paragraph Font<O< Heading (5CJ0\aJ0,, Header  !<O< !!!!!!7 footer  !2"2 intro xCJ aJ &)@1& Page Number,OB, Heads5CJ$\aJ$ROARR Question($$ >]^`>CJaJPOQbP #ques+ hvv]^v`CJ aJ (r( 14ptxCJaJ*q* 14ptcent$a$88 16pt$ B  a$CJ aJ .Q. Question1 2 ]2 `` !!!!!!-$$ vvx7$8$^v`_HaJmH sH tH DD secondline  Bx<CJaJ66 box1$$  xaJZZ Answer-a1.$$   >xx^`>>*aJLL 3chbox+tab B  .  xCJaJ.. 3chboxfirst XX 2chboxfirst(!  B ^`CJaJV"V !!!!!!ep"0x1$7$8$^`0_HaJmH sH tH V2V Answer-a2.#$$  >xx^`>aJ>OQB> blanklines$$$B^`BTRT Answer-a.%$$ d >xx^`>aJFbF 6chboxfirst&    4Qr4 Answer-6' d PQP instruction"( ]^`5\TT !!!!!!1)>x1$7$8$^`>_HaJmH sH tH XX boxes5s4*$$ *  xx^`aJNN Answer++$$  >xx^`>aJJYJ Document Map,-D M OJQJ^J.U@. Hyperlink >*B*phr r K r r  !8@0(  B S  ?rdpscdnps Robin GrantUC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of KDQOL User Survey.asd Robin Grant.C:\WPDOCS\Ron Hays\KDQOL\KDQOL User Survey.doc Robin Grant.C:\WPDOCS\Ron Hays\KDQOL\KDQOL User Survey.doc Robin Grant.C:\WPDOCS\Ron Hays\KDQOL\KDQOL User Survey.doc Robin GrantUC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of KDQOL User Survey.asd Robin GrantUC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of KDQOL User Survey.asd Robin GrantUC:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of KDQOL User Survey.asdDepartment of Medicine;C:\windows\TEMP\AutoRecovery save of KDQOL User Survey1.asdDepartment of Medicine1C:\projects\webstuff\kdqol\KDQOL User Survey1.doc KSpritzer6C:\projects\FrontPageWebs\KDQOL\KDQOL User Survey1.docX'g3@|<^<`.'g3@\\DOMPS01\BROXTON-228-LJ4000Ne04:winspoolHP LaserJet 4000 Series PCL\\DOMPS01\BROXTON-228-LJ40004C odXXLetter DINU"47խ \\DOMPS01\BROXTON-228-LJ40004C odXXLetter DINU"47խ ȧJr@@GzTimes New Roman5Symbol3& zArial5& zTahoma"Ah _PID_GUIDAN{1B8A516C-A339-11D4-A36D-00C04F364D20} !"#$%&')*+,-./2Root Entry F,<Ƭ41TableWordDocument" SummaryInformation( DocumentSummaryInformation8(CompObjjObjectPoolƬƬ  FMicrosoft Word Document MSWordDocWord.Document.89q