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1. Pemat Form (xls file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/publications/files/pemat_form.xls
   November 01, 2013 - PEMAT Patient Education Materials Assessment Tool (PEMAT) Auto-Scoring Form   An Instrument To … You may refer to the material at any time while you complete the form. … This PEMAT Auto-Scoring Form automatically calculates an overall understandability and actionability

2. Medicine-Review-Form (doc file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/medicine-review-form.docx
   March 01, 2024 - Medicine Review Form Patient Name/ Number: _____________________________________________ Date: _ … Thank you for completing this form. You are now done. 9.

3. Action-Plan-Form (doc file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form.docx
   March 01, 2024 - Action Plan Form My visit with: Date: What I want to do for my health: |_| Eat better

4. Patient-Portal-Form (doc file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/patient-portal-form.docx
   March 01, 2024 - Patient Portal Feedback Form Instructions: These questions are meant to guide your collection of feedback … After they are done, ask the following questions and use this form to record responses. 1.

5. Communication-Observation-Form (doc file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/communication-observation-form.docx
   March 01, 2024 - Communication Observation Form Please observe the interaction between a patient and a clinician.

6. Community-Referral-Form (doc file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/community-referral-form.docx
   March 01, 2024 - Community Referral Form: [Practice Name] Reason for Referral_________________________________ Name of … _____________________________________________________________________ Example Community Referral Form … Community Referral Form: City Medical Care Reason for Referral Education Classes Name of Program

7. Pemat Form (xls file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat_form.xls
   November 01, 2013 - PEMAT Patient Education Materials Assessment Tool (PEMAT) Auto-Scoring Form   An Instrument To … You may refer to the material at any time while you complete the form. … This PEMAT Auto-Scoring Form automatically calculates an overall understandability and actionability

8. Self-Assessment Form (pdf file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_selfasst.pdf
   April 24, 2017 - Self-Assessment Form Coaching Workshop ASTD Coaching Self-Assessment Form INSTRUCTIONS … TeamSTEPPS 2.0 for Long-Term Care ASTD Coaching Self-Assessment Form – D-9-31 Coaching Workshop … ASTD Coaching Self-Assessment Form – D-9-32 TeamSTEPPS 2.0 for Long-Term Care Coaching Workshop … TeamSTEPPS 2.0 for Long-Term Care ASTD Coaching Self-Assessment Form – D-9-33 Coaching Workshop … ASTD Coaching Self-Assessment Form – D-9-34 TeamSTEPPS 2.0 for Long-Term Care

9. Coaching Feedback Form (pdf file)
   ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_feedback.pdf
   April 24, 2017 - Coaching Feedback Form Coaching Workshop Coaching Feedback Form INSTRUCTIONS: While observing … the scripted coaching practice exercise, use this form to document the demonstrated competencies of … particular scenario, and the observer watches the interaction and notes on the coaching observation form … Responding to Requests Following Through TeamSTEPPS 2.0 for Long-Term Care Coaching Feedback Form

10. Chart Abstraction Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-203-section-2-tech-specs.pdf
    December 14, 2011 - Chart Abstraction Form Basic Elements Patient ID Race Ethnicity Gender … 14 15 16 17 18 19 20 21 22 23 lad895 Typewritten Text Attachment 2.1 Chart Abstraction Form

11. TeamSTEPPS Coaching Feedback Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-coaching-feedback-form.pdf
    May 31, 2023 - TeamSTEPPS Coaching Feedback Form Coaching Feedback Form INSTRUCTIONS While observing the scripted … coaching practice exercise, use this form to document the demonstrated competencies of the designated … particular scenario, and the observer watches the interaction and notes on the coaching observation form … Difficult Situations Execution Responding to Requests Following Through Coaching Feedback Form

12. TeamSTEPPS Training Evaluation Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-course-evaluation-form.pdf
    June 01, 2023 - TeamSTEPPS Training Evaluation Form TeamSTEPPS Training Evaluation Form The TeamSTEPPS … course evaluation form that follows is designed for a 2 day course based on the TeamSTEPPS curriculum … include all the material covered in a 2 day course, you may need to remove sections of the evaluation form … TeamSTEPPS Training Evaluation Form 2 Location: ___________________________ Date: __________ … Additional Comments: TeamSTEPPS Training Evaluation Form

13. Action-Plan-Form-Example (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form-example.docx
    August 25, 2023 - Action Plan Form Example My visit with: Dr.

14. ASTD Coaching Self-Assessment Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/astd-coaching-self-assessment-form.pdf
    May 31, 2023 - ASTD Coaching Self-Assessment Form … ASTD Coaching Self-Assessment Form Instructions … ☐ ☐ ☐ ☐ ASTD Coaching Self-Assessment Form 2 … ASTD Coaching Self-Assessment Form 4 … Reference: Chen, Chris, Coaching Training, ASTD, 2003 ASTD Coaching Self-Assessment Form 6 ASTD

15. CAHPS Data Research Abstract Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/data-research/cahps-data-research-abstract-form.pdf
    January 01, 2024 - CAHPS Data Research Abstract Form CAHPS Database Research Abstract Form – January 2024 1 Agency for … Healthcare Research and Quality (AHRQ) CAHPS® Database Research Abstract Form Instructions Please … use this form to describe the research for which you require AHRQ Consumer Assessment of Healthcare … Save this completed form with your last name in the file name (e.g., “Smith CAHPS Research Abstract.doc … CAHPS Database Research Abstract Form – January 2024 2 Methodology [Specify measures and proposed

16. Team-Antibiotic-Review-Form (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/team-antibiotic-review-form.docx
    November 01, 2019 - AHRQ Safety Program for Improving Antibiotic Use Team Antibiotic Review Form *Questions 1–6 should … ☐ Yes ☐ No 2 Team Antibiotic Review Form AHRQ Safety Program for Improving Antibiotic Use – … Otherwise this form has been completed.

17. CAHPS Data Research Abstract Form Example (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/data-research/example-cahps-data-research-abstract-form.pdf
    January 01, 2024 - CAHPS Data Research Abstract Form Example CAHPS Database Research Abstract Form – January 2024 1 … Agency for Healthcare Research and Quality (AHRQ) CAHPS® Database Research Abstract Form EXAMPLE … OF A COMPLETED FORM This completed abstract presents an example of how to complete this form. … Abstract Form. … CAHPS Database Research Abstract Form – January 2024

18. Easy-To-Understand-Telehealth-Consent-Form (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/easy-to-understand-telehealth-consent-form.docx
    April 15, 2020 - .] · It will be as if you never signed this form. How much does a telehealth visit cost?  … Do not sign this form until you start your first telehealth visit.

19. Identifying-Antibiotic-Adverse-Events-Form (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/identifying-antibiotic-adverse-events-form.docx
    November 01, 2019 - Improving Antibiotic Use Identifying Antibiotic-Associated Adverse Events Form … PURPOSE OF THIS FORM: To discuss issues that may result in unnecessary antibiotic administration … All health care providers are encouraged to complete this form. … Consider completing this form at least twice a year.

20. Completion Guide_Team Antibiotic Review Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/team-antibiotic-review-form-completion-guide.pdf
    November 01, 2019 - Completion Guide_Team Antibiotic Review Form AHRQ Safety Program for Improving Antibiotic Use … Completion Guide for the Team Antibiotic Review Form Questions 1–6 should be answered for … Safety Program for Improving Antibiotic Use – Acute Care Completion Guide Team Antibiotic Review Form … No. 17(20)-0028-EF November 2019 Completion Guide for the Team Antibiotic Review Form Questions