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Appendix 2: Patient Information Sheet
Audit of the Extent and Severity of Cycle
Accidents
Information for patients
Why are we undertaking this study?
This study is being undertaken on behalf of the Scottish
Executive. We are undertaking this study across all
hospitals in Lothian and Borders area to measure the number
of cycling accidents that take place and the severity of
injury caused by these accidents. The data collected will
be used to inform road safety campaigns and to help make
cycling safer.
Why should you provide information?
In order for our measurement of accidents to be accurate
we need everybody who has been involved in a cycling
accident to give us details of their accident. This
includes only those who were on a cycle at the time of the
accident and would not for example include a pedestrian who
has been injured by a cycle.
How to fill out the form
The form is designed to be easy and simple to complete.
It should only take a minute of your time. You may be asked
to complete the first section yourself or the staff may
help you to complete it. If you have any difficulties
please ask for help in completing it. Please provide as
much information as you are able by ticking the boxes or
writing in where asked. If you do not know the answer to a
question leave it blank.
On completing the top section of the form please return
it to the clinical staff.
The bottom section of the form is to be completed by the
clinical staff for them to record the type of injury.
Confidentiality
The form does not contain any information about your
name or your address and so the information you provide
will be held anonymously.
Any concerns?
Should you have any concerns relating to this study
please contact Carole Millar on 0131 552 1646 or Hamish
Clark at the Scottish Executive on 0131 244 7559.
Thank you
We would like to take this opportunity to thank you in
advance for taking the time to provide information for this
study. It is essential for this study to be a success that
everybody does take part.
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