The code block below illustrates how one might use # and // as comments in your logic and calculations.

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87JVxPtF6wpi5EXpaJGzzV82pDV8KHMNvRb9XcvnKm3aMT3qvAcMxJiPACuC5vJDcRzZCu

Elder Care Medicine Network

Welcome.

We are working to build the "Elder Care Medicine Network". This project is funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award #21121. We are three regional partners – Midwest, MidAtlantic and Hawaii Region.

The Elder Care Medicine Network will include older individuals (65 years of age and above), caregivers, researchers, and pharmacists, as engaged partners in patient centered outcomes research (PCOR). The goal of this network is to guide research efforts about the best use of medicines that are important to you and the people you care about. This means taking the right medicines at the right time for you.

Please take a moment to share your information below. Your information will only be used for network related activities.

Please note: We are aware of the changing conditions of this time, brought about by COVID-19. We will make every effort to consider your safety, convenience, and capacity, as we carry forward the Elder Care Medicine Network's mission and vision.

To learn more about the Elder Care Medicine Network, click on this link (network overview)

Attachment:NetworkOverview.docx

Please provide us your name (first, last)

Please provide us with your State and zip code

Please tell us your age

44 years or younger

45-64 years

65-74 years

75-84 years

85 years or older

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Which of these groups would you identify as your main role (primary stakeholder community)?

(check all that apply)

Older adult (65 years of age and above)

Caregiver or family member of an older adult

Clinician

Researcher

Other

If you checked "Caregiver or family member of an older adult" – feel free to share any thoughts or comments

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If you checked "Clinician" – write the type of clinician you are, the kind of patients you serve, and/or any other comments

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If you checked "Researcher" – write the type of research you conduct, any specialty areas, and/or any other comments

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If you checked "Other" – please explain

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By which of these methods would you prefer to be contacted?

(check all that apply; once you check the box, the slot to provide contact info will appear below)

Phone

Mail

If you chose Email communication:

Please provide your email address here

If you chose phone communication:

Please provide your phone number here

If you chose Mail communication:

Please provide your address here

Can you commit to about 1 hour (or so) per month for the Elder Care Medicine Network?

Yes

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If not able to commit, would you still like to stay informed about the Elder Care Medicine Network?

Yes

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Thank you for your interest!

Once you click on 'Submit', you will receive information about how to stay in touch and whom to contact if you have any questions or feedback

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.