Draft Guiding Principles for Patient Reported Measures - About you - Western Australia Department of Health

Which of the following role/s best represent you?

(Required) Consumer (ie. a person who uses health services) Carer or family member of a person who uses health services Carer representative (eg, member on Consumer Advisory Group/Council, District Health Advisory Council, Health Service Board member) Consumer representative (eg. member on Consumer Advisory Group/Council, District Health Advisory Council, Health Service Board member) General medical practitioner Specialist medical practitioner Nurse Nurse Practitioner Midwife Allied Health practitioner Community or aged care staff member Researcher, academic or educator Peak body, non-government organisation or community organisation representative Health administrator (planning, policy development and business support) Other (please specify below)

Other:

Which category best describes your PRIMARY place of work?

(Required) Not applicable – I am responding as a consumer/carer Child and Adolescent Health Service (CAHS) East Metropolitan Health Service (EMHS) North Metropolitan Health Service (NMHS) PathWest Laboratory Medicine WA South Metropolitan Health Service (SMHS) WA Country Health Service (WACHS) WA Department of Health Private health provider General Practice Academic/teaching/research institution Peak body Other government agency (e.g. Mental Health Commission) Other (please specify below)

Other:

Are you providing your views as an individual or on behalf of a group/organisation?

(Required) Individual Group/organisation

Name of group / organisation: