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5-MINUTE PATIENT ASSESSMENT

ESRD NETWORK 5



PATIENT ASSESSMENT
 

Quality Insights ESRD Network 5 needs your input and help!


We’d like to gather feedback directly from the individuals most impacted by the lack of accessible oral health care. The more input we receive from patients and providers, the better the development for eventual resources, guidance, and materials to improve oral health and health outcomes for individuals with chronic kidney disease and those at risk of developing kidney disease.


As a “THANK YOU” to those who complete the patient or provider assessment, you can be entered into a drawing for a $100 gift card to Amazon, Walmart, or Door Dash! Entry into the drawing is optional; to enter provide your contact information at the end of the assessment.


PATIENT ASSESSMENT

 

Drawing guidelines:

  • Completion of the assessment may be anonymous. Anonymous submissions will be excluded from the drawing.
  • Persons completing the assessment who wish to enter this drawing must provide their contact information at the end of the assessment.
  • 3 winners will be selected. Winner may be a patient or healthcare provider.
  • Each winner will be notified by email using the email provided at the end of the assessment.
  • Each winner will receive one of the 3 gift cards available by random assignment (i.e. winners cannot request a specific gift card).
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