Permission to Use the CONGENITAL ADRENAL HYPERPLASIA KNOWLEDGE ASSESSMENT QUESTIONNAIRE

 

FROM:
Jennie King, CNC: jenmking@nsccahs.health.nsw.gov.au
Irene Mitchelhill CNC: Irene.mitchelhill@health.nsw.gov.au

RE: Use of the Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire

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You are free to use the Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire (CAHKAQ) for your research. The instrument is copyrighted (c. 2007, King, Mitchelhill & Fisher) and may not be duplicated or copied without first submitting a signed copy of this permission form to J King. Requests for any changes or alterations to the instrument should be made in writing to J King. As with all revisions, the copyright will be retained by King, Mitchelhill & Fisher and must appear on the printed copies of the instrument. The Authors of the CAHKAQ retain the copyright of all translated versions of the CAHKAQ.

By filling in your name, address, phone number, and e-mail address and signing the agreement use below and mailing it to J King, you are hereby given permission to use the Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire for your research. The permission is valid only for the study/purpose named below.

King, Mitchelhill & Fisher requests that you send back the following information:

  • your raw data in ASCII format for our reliability and validity bank
  • copies of any changes or translations of the scale
  • copies of any publications citing the use of the scale

When using the Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire you need to use the following reference:

CAHKAQ English version ISBN: 978-0-9874497-3-3

King J, Mitchelhill I, Fisher M (2007) Development of the congenital adrenal hyperplasia knowledge assessment questionnaire (CAHKAQ). Journal of Clinical Nursing, 17(13): 1689-1696.

AGREEMENT to Use the CONGENITAL ADRENAL HYPERPLASIA KNOWLEDGE ASSESSMENT QUESTIONNAIRE

 

I agree to the above conditions for using the Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire.

Name:

Title:

E-mail:

Address:

Academic/business affiliation:

Phone Number:

Study Title:

Brief Description of Study:

 

 

 

 

Signature___________________________________Date__________________________

Please keep a copy of this form in your files.

Email to:

Jennie King, CNC: jenmking@nsccahs.health.nsw.gov.au

Irene Mitchelhill CNC: Irene.mitchelhill@health.nsw.gov.au

 

Example images below:

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