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Welcome, and thank you for taking an interest in this extremely important survey. No personal information is being retreived from this form, and you will be answering on a completely anonymous basis. Your responses to these questions may help to determine the course of several important changes in Emergency Medical Care and your access to your own Electronic Medical Records. Please answer all 16 questions honestly, then click the "Submit My Responses" button. That's all there is to it!
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| 1) |
If you could have all of your emergency medical information in one place would it benefit you? |
Yes
No
Maybe |
| 2) |
Would you agree to have all of your medical information on a secure web site for access to you 24/7 from any computer? |
Yes
No
Maybe |
| 3) |
Would you agree to have your emergency medical information placed on a secure web site and allow medical personnel treating you to have access to it 24/7? |
Yes
No
Maybe |
| 4) |
Would you place a decal in obvious places such as your front door and car window that would alert medical personnel that you have a computer card that they can use to access all of your emergency medical information? |
Yes
No
Maybe |
| 5) |
Would you allow medical personnel access to a complete listing of your medical information to include your age, insurance information, allergies, medications, past medical history including treatments, surgeries, medical diagnosis, labs, and other tests, as well as your wishes regarding your living will, your medical and durable power of attorneys’, physician and emergency contact lists and organ donor status? |
Yes
No
Maybe |
| 6) |
If possible would you allow your medical information to be securely shared between hospitals/physicians to allow rapid access of your medical information by a facility treating you? |
Yes
No
Maybe |
| 7) |
Would you allow access of your medical records at your family physician’s office and allow other doctors authorized by you to access your complete medical information? |
Yes
No
Maybe |
| 8) |
If you had easy access to update your medical information would you do so as changes occur? |
Yes
No
Maybe |
| 9) |
Would you allow your doctor or hospital where you were treated to update your medical information? |
Yes
No
Maybe |
| 10) |
If this service was available from your insurance company at a cost of $2.00 a month, added to your monthly premium would that be a benefit? |
Yes
No
Maybe |
| 11) |
Do you feel a service like this could make a difference in your care? |
Yes
No
Maybe |
| 12) |
If this service included links to medical information for education, treatment, information on medications, and preventative healthcare options would you use those? |
Yes
No
Maybe |
| 13) |
Would you answer follow up questions on the educational services you use to assess their benefit? |
Yes
No
Maybe |
| 14) |
Would you be willing to suggest other medical/educational links that you have found to be beneficial? |
Yes
No
Maybe |
| 15) |
If this service was available would you use it? |
Yes
No
Maybe |
| 16) |
If this service was available would you pay $50.00 per year to have it? |
Yes
No
Maybe |