Questionnaire for the Obama Administration

[Guest guest]

I apologize if this has already been posted. Faye Manaster< Porject

Director of the Arc of Illinois Family to Family Health Information

and Education Center asked if I would post this:

The Arc of Illinois

December 26, 2008

Leaders in The Arc:

Please share this with others. Note quick timeframe for the questionnaire.

Happy Holidays!

Tony auski

The Arc of Illinois

815-...

President-elect Obama is currently reaching out to the American people

and asking us to share both our stories about experiences with the

health care system, and our ideas for improving health care.

During the last 2 weeks of December 2008, many public Health Care

Forums are being held around the U.S. , giving Americans the

opportunity to meet and discuss their ideas about health care issues

and submit them to President-elect Obama's website,

http://change.gov/agenda/health_care_agenda/

The Arc of Illinois Family to Family Health Information and Education

staff, Faye Manaster and Roseann Slaght, participated in a Health Care

Forum in Chicago on 12/1908, targeted at persons with disabilities and

their families.

All in attendance were asked to reach out to others in their

communities and publicize this opportunity to share ideas and

experiences with the Obama Transition Team.

Here is a short questionnaire for you to use in sharing your

stories and suggestions.

Please call us at 866-931-1110... if you have any questions or need

more information.

Thank you and best wishes for happy holidays and a healthy New Year.

The Arc of Illinois

Family to Family Health Information and Education Center

www.thearcofil.org/familytofamily familytofamily@...

708-560-6703... (voice) 866—931-1110... (toll free for Illinois

families)

President-elect Obama's Health Care and Therapy Community Forum

Family Story Form for Persons with Disabilities and their Families:

Have you had problems getting medically-necessary therapy services?

Please take a few minutes to share your story.

We are collecting information from consumers and families around the

state and will submit them to The Office of the President-Elect at

www.change.gov

Stories are due by January 4,2008

Please answer as many of the questions below as possible .

Please email to Faye Manaster: familytofamily@...

Or fax to 815-.464-5292.

Family Story Information Form

Your name: _________________________________________________

Phone #:____________________________________________________

Address: ____________________________________________________

E-mail:______________________________________________________

County _____________________________________________________

Person(s) in your family who have a disability or special health care

needs, their age(s), and type of special needs:(disability and/or

chronic illness)__________________________________________________________

________________________________________________________________

What has been your biggest problem in getting needed therapy services?

Have you had any problems in paying for therapy services? If yes, tell

us what the problem has been:

3. What happens when therapy needs are not met? How does this

impact the ability to do things each day?

4.What percent of your therapy needs are not met each year?

5. Do you have other unmet needs related to your disability/chronic

illness? Please tell us more about them.

6.Do you/your family have health insurance now?

___Yes ___No

7.If you do not have insurance, what is the reason ?

__________________________________________________________

8.If you have insurance, is it: Medicare____ Medicaid____ All Kids____

Private insurance ____(either from your job or an individual policy)

Other (please specify)______________military health insurance _____

9.I have insurance, but it costs too much. It is equal to ______% of

my monthly income OR my monthly cost is__$________

10. What else do you want to tell President-Elect Obama about your

health insurance situation and ideas to make things better?

Sincerely,

Tony auski, Executive Director

Faye Manaster, Family to Family Project Director

Rose Slaght, Family to Family Project Assistant

Faye Manaster,M.Ed.

Project Director

The Arc of Illinois Family to Family Health Information and Education

Center

The Arc of Illinois

20901 South LaGrange Road

fort, IL 60423

815-464-8247

708-560-6703 (voice)

815-464-5292 (fax)

familytofamily@...

www.thearcofil.org/familytofamily