Law Law 6842-01  Winter, 2011
American Health Care Law
Professor Vernellia R. Randall
The University of Dayton School of Law

 

Personal Health Care Experience
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Health Care Experience
Have you been hospitalized in the last 5 years?
Has anyone in your immediate family been hospitalized in the last 5 years?
Have you (or your significant other) had a child?
Do you or anyone in your immediate family have a chronic illness?
Has anyone in your immediate family experienced a life threatening or disabling illness?
Have you experience a death in your immediate family?
Has anyone in your immediate family been a resident in a nursing home?
Have you ever been to an emergency room for health care?

Source and Payment of Health Care
Have you been without health insurance for more than 6 months?
Do you now have health insurance?
Have you ever been to an emergency room because you couldn't afford to go to the doctor?
Have you ever not seen a doctor when you needed to because you didn't have money or insurance?
Has anyone in your immediate family had Medicare?
Has anyone in your immediate family been on Medicaid?
Have you ever been a patient in  the military health care system?
Have you ever been a patient in the Indian Health Service system?
Have you ever received services as a member of an HMO?

Work or Employment  Experience
Are you a health care professional?
Have you ever worked or volunteered  
nursing home?
a hospital?
doctor's office?
a pharmacy?
Other Health Care Office?
in a government health department or public health?
for a health care insurance company?
for an HMO?
Are there any health care professionals in your immediate family? (parents, siblings, grandparents, children)
Complete the following questions if you are a student in the Health Care Law Class:
Last Name:        First Name:      Year:
What was your undergraduate major? 
What was your graduate major?           

I use the following demographic information to help assure balance groups:
How old are you? 
What is your Gender? 
What is your racial /ethnic background? 
What kind of town/city did you spend your teenage or young adult years?
 

STOP!! Print a copy of this page for your record BEFORE submitting it and keep it for your record.

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Last Updated:
 12/05/2010

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Contact Information:
Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu

 

Copyright @ 1994. Vernellia R. Randall 
All Rights Reserved