Informational Needs Assessment Survey

for Improving Pediatric Palliative Care

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We thank you in advance for taking the time to fill out this survey. We know this is a difficult subject. A group of service providers and families have created a coalition in Pittsburgh that is working to improve the care of medically fragile children and their families.  In order to achieve this mission, we have created two different needs assessment surveys to document the needs and experiences of caregivers for medically fragile children and those who have experienced the death of a child.  The survey should take between 15 -20 minutes of your time.  Please return it by February 18 if possible.  All information will be confidential and analyzed independently by the Bayer Center for Nonprofit Management at Robert Morris University.  By completing this survey, you will be a part of improving the health care system for future children and their families of Western Pennsylvania!

Sincerely, 
A. Meghan O’Donnell (Parent and Co-Founder of PPPCC)
Pittsburgh Pediatric Palliative Care Coalition

If you have any questions, comments or suggestions, please feel free to contact Yvonne Van Haitsma at the Bayer Center for Nonprofit Management at Robert Morris University at 412-227-6874 or email Yvonne Van Haitsma (vanhaitsma@rmu.edu).

Please download the appropriate document, complete it and mail it to:
     Ms. Yvonne van Haitsma
     Collaboration Project Director
     Bayer Center for Nonprofit Management
     Robert Morris University
     718 Fifth Avenue
     Pittsburgh, PA 15219
        
Phone:  (412) 227-6874
           Fax:  (412) 227-4097


SURVEY FOR FAMILIES WHOSE CHILD IS MEDICALLY FRAGILE
(click to download: pdf - format)

SURVEY FOR FAMILIES WHO HAVE EXPERIENCED THE DEATH OF A CHILD
(click to download: pdf - format)


Alternatively, you can download the appropriate document in rich text format (rtf), complete it manually and mail it OR complete it electronically and email it to Yvonne Van Haitsma at vanhaitsma@rmu.edu.

SURVEY FOR FAMILIES WHOSE CHILD IS MEDICALLY FRAGILE
(click to download: MS Word rtf - format)

SURVEY FOR FAMILIES WHO HAVE EXPERIENCED THE DEATH OF A CHILD
(click to download: MS Word rtf - format)


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© Copyright PPPCC 2004-2005, All Rights Reserved.
(In Memory of Danny Bauer)