Sample_Bereavement_Survey_Intro_Letter_.pdf

DEPARTMENT OF VETERANS AFFAIRS

Medical Center

3900 Woodland Avenue Philadelphia, PA 19104

«MergeID» «Date» «FirstName» «LastName» «Address1» «Address2» «City», «State» «Zip»

Dear «Name» «Last Name», Your opinion and input is important to us. Enclosed is a survey I ask you to complete and send back to us to help VA improve the care delivered to seriously ill Veterans. A pre-addressed, stamped envelope is included for your convenience. Your participation is voluntary and confidential, and will not affect your benefits in any way. If you choose to participate in the survey, please return it to us at your earliest convenience.

I offer our condolences on the loss of «Vet_First» «Vet_Last» «Vet_Suffix». This may be a difficult time for you, however, I ask for your help in improving the care that VA provides to Veterans. Ensuring high quality healthcare for Veterans is central to the VA mission and input from Veterans’ family and friends is among the most important feedback we use to learn more about what VA did well and what VA could have done better.

Note, you may also complete the survey online.

To access the survey online:

Log on to https://www.research.net/r/InpatientM?ID=«MergeID» Enter your password: «MergeID»

Or, if you’d prefer to complete the survey over the phone, please call the Veteran Experience Center toll-free at 1-877- 503-5817 and reference #«MergeID». If you feel you are not the person who is best able to answer questions about the care «Vet_First» «Vet_Last» «Vet_Suffix» received in the last month of life, please call us with the name, address, and phone number of the person who may be better able to answer these questions.

If you would like to speak to someone about benefits or other resources, you may call the VA Office of Survivors Assistance at 202-461-1077 or the VA Benefits Assistance Service at 800-827-1000.

Thank you for your time and commitment to improving the care of Veterans and their families.

Sincerely, Scott T. Shreve, DO Corporal Michael J. Crescenz VAMC - Philadelphia

Usted ha recibido esta carta del Departamento de Asuntos para Veteranos en relación a una encuesta acerca del cuido recibido por «Vet_First» «Vet_Last» «Vet_Suffix» en el Hospital de Veteranos en su último mes de vida. Por favor si desea recibir más información en español comuníquese con nosotros al 1-877-503-5817 y refiérase al número #«MergeID».

THE OFFICE OF MANAGEMENT AND BUDGET HAS APPROVED THIS SURVEY UNDER OMB NUMBER 2900-0701 IN ACCORDANCE WITH SECTION 3507 OF THE PAPERWORK REDUCTION ACT OF 1995. WE ESTIMATE THAT IT WILL TAKE ABOUT 10 MINUTES TO ANSWER THESE QUESTIONS. YOUR RESPONSES WILL BE USED TO MEASURE VETERANS’ AND FAMILIES’ PERCEPTIONS OF THE HEALTHCARE VA PROVIDES. YOUR PARTICIPATION IS VOLUNTARY AND CONFIDENTIAL. IF YOU CHOOSE NOT TO PARTICIPATE, IT WILL NOT AFFECT

YOUR BENEFITS IN ANY WAY.

https://www.research.net/r/InpatientM?ID=