Survivor and Family Online Survey To identify problems and solutions after ARDS

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		Gordon D. Rubenfeld, MD MSc Associate Professor Division of Pulmonary and Critical Care Medicine Box 359762 Harborview Medical Center 325 9th Ave Seattle WA 98104-2499 FAX: 206.731.8584
Q1	I am a survivor of ARDS (if NO, skip to Q6)
	YES
	NO
Q2	Current AGE Years
Q3	Year in hospital with ARDS
Q4	Reason you had ARDS (check one)
	Pneumonia
	Trauma (motor vehicle crash, etc)
	Inflammation of pancreas
	Pregnancy
	After major surgery
	Chemotherapy
	Other
	Don't know
Q5	Who helped you get better after your ARDS? (check all that apply)
	Husband/Wife
	Brother/Sister
	Children
	Other family members
	Co-workers
	Friends
	Myself
	Other
Q6	We are very interested in the problems you encountered as you (or your loved one) recovered from ARDS. This includes medical problems like skin ulcers and pain, psychological and social problems like depression and getting back to your regular life, and other physical problems like weakness, numbness, and mobility.
	Type your answer in the box below.
Q7	We would like to know about treatments, resources, or clinicians that you (or your loved one) found to really improve your recovery after ARDS. Tell us as much detail as you can about the things that helped you get better once you left the hospital.
	Type your answer in the box below.
Q8	We would also like to know about treatments, resources, or clinicians that you (or your loved one) tried but found that they really didn't help you much at all. Tell us as much detail as you can about the things you tried that didn't work.
	Type your answer in the box below.
Q9	Finally, sometimes people run into problems getting the services they need. Tell us about the problems you had with insurance companies, hospitals, transportation, and doctors or other clinicians in trying to get treatments after ARDS.
	Type your answer in the box below.

Thank you very much for your help and time, Click here for printable survey

Gordon Rubenfeld  

ARDS Foundation
3330 Dundee Rd. Suite C4
Northbrook, IL 60062
PH: 312-749-7047

Eileen Rubin Zacharias, President
Paula Blonski, Vice President

The ARDS Foundation

All donations are tax deductible in the amount allowed by the law. The ARDS Foundation is a federal 501(c)(3) organization.

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