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1. Coaching Feedback Form (pdf file)
   patientregistry.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

2. TeamSTEPPS Coaching Feedback Form (pdf file)
   patientregistry.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

3. TeamSTEPPS Training Evaluation Form (pdf file)
   patientregistry.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

4. ASTD Coaching Self-Assessment Form (pdf file)
   patientregistry.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

5. Team-Antibiotic-Review-Form (doc file)
   patientregistry.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.

6. AHRQ’s Easy-to-Understand Telehealth Consent Form | Agency for Healthcare Research and Quality
   patientregistry.ahrq.gov/health-literacy/improve/informed-consent/index.html
   September 01, 2020 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Why should we use easy-to-understand telehealth consent forms? … Put your logo on the form. Check with your lawyer before using the form. … If patients cannot use a patient portal, you can mail consent forms (one to sign and return, one for … Clinicians can ask patients to sign and mail back the form.

7. Team Antibiotic Review Form | Agency for Healthcare Research and Quality
   patientregistry.ahrq.gov/antibiotic-use/acute-care/improve/team-review.html
   November 01, 2019 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Hospital Toolkit Develop and Improve Stewardship Program Team Antibiotic Review Form … Stewardship Bedside Nurse Collaborate With Microbiology Lab Team Antibiotic Review Form … Ambulatory Care Toolkit Long-Term Care Toolkit Team Antibiotic Review Form … Team Antibiotic Review Form  (DOCX) Completion Guide for Team Antibiotic Review Form  (PDF

8. EvidenceNOW: Implementation Tracking Form | Agency for Healthcare Research and Quality
   patientregistry.ahrq.gov/evidencenow/projects/heart-health/research-results/research/implementation-tracking-sw.html
   March 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Research and Results Research Design and Methods EvidenceNOW: Implementation Tracking Form … Incontinence Tools for Change EvidenceNOW: Implementation Tracking Form … Implementation Tracking Note—Southwest Cooperative (PDF, 363.33 KB, 2 pages) This intervention tracking form … originally created January 2019 Internet Citation: EvidenceNOW: Implementation Tracking Form

9. EvidenceNOW: Intervention Tracking Field Note Form | Agency for Healthcare Research and Quality
   patientregistry.ahrq.gov/evidencenow/projects/heart-health/research-results/research/intervention-tracking-notes-sw.html
   March 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Results Research Design and Methods EvidenceNOW: Intervention Tracking Field Note Form … Southwest Cooperative Resource: Field Note Tracking Form—Southwest Cooperative (PDF, 151.3 … KB, 5 pages) This implementation tracking form was used by an EvidenceNOW Cooperative's staff to document … created January 2019 Internet Citation: EvidenceNOW: Intervention Tracking Field Note Form

10. TeamSTEPPS Measurement Tools | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/teamstepps-program/resources/tools/index.html
    January 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms …  (PDF, 161 KB) This form will guide you through a self-evaluation exercise that will assist you in … observer uses this form to document the demonstrated competencies of the designated coach. … TeamSTEPPS Readiness Assessment Form (PDF, 134 KB) This PDF helps institutions answer the question … TeamSTEPPS Training: Evaluation Form (PDF, 354 KB) This course evaluation form for a two-day TeamSTEPPS

11. How to Obtain Consent for Telehealth | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/health-literacy/improve/informed-consent/obtain.html
    September 01, 2020 - Grant Application, Review & Award Process Grant Application Basics Application Forms … and Funding How to Obtain Consent for Telehealth The purpose of consent forms … Offer to read the form aloud to all patients. … If patients can’t use the patient portal, mail consent forms (one to sign and return, one to keep) and … You do not need to wait to get a consent form signed.

12. Toolkit 1. Suspected UTI SBAR Toolkit | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit1-suspected-uti-sbar.html
    October 01, 2016 - Grant Application, Review & Award Process Grant Application Basics Application Forms … The primary tool in this toolkit is the Suspected UTI SBAR form. … The toolkit includes the following tools: Suspected UTI SBAR form (tool 1) ( PDF ) also available … Introduce the Suspected UTI SBAR form to prescribing clinicians. … for using the form, and a discussion about available technical support.

13. SOPS Research Datasets | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/sops/databases/research-datasets.html
    March 01, 2023 - Grant Application, Review & Award Process Grant Application Basics Application Forms … SOPS De-Identified Data Research Abstract Form (Word, 32 KB)—Researchers requesting de-identified data … must submit a completed form outlining the proposed use of the data. … Sample SOPS De-Identified Data Research Abstract Form (PDF, 376 KB)—Shows the form completed with sample … data must submit a completed form outlining the proposed use of the data.

14. Forms and Electronic Applications | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/funding/process/app-forms/index.html
    November 01, 2015 - change from paper to electronic filing, the current PHS 398 application will be replaced by the Standard Form … Following this advice will ensure you have the latest forms and correct application package. … Research Grants Form/Application Instructions Description/Comments SF424 (R&R) (Word File, 26 … Fishers Lane Rockville, MD 20857 Phone: (301) 427-1447 Fax: (301) 427-1462 Fellowships Form … Kirschstein National Research Service Award Individual Fellowship Application Form ** to be used ONLY

15. Raise Awareness: Tool 3 | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/health-literacy/improve/precautions/tool3.html
    February 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Health Literacy Universal Precautions Toolkit, 3rd Edition Introduction Quick Start Guide Form … Key Strategies for Clear Communication Communication Self-Assessment Communication Observation Form … Insurance Release of Medical Information Appointment Reminder Letter Inclusive Language for Intake Forms … Help With Medicines Poster Get Patient Feedback: Tool 17 Patient Portal Feedback Form Suggestion

16. Background Quality Improvement Team Information Form | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/hai/cusp/toolkit/bckgrnd-qi-team.html
    December 01, 2012 - Grant Application, Review & Award Process Grant Application Basics Application Forms … About the CUSP Method Modules Background Quality Improvement Team Information Form … Universal and Targeted Tools Background Quality Improvement Team Information Form … Alternate Formats Background Quality Improvement Team Information Form [ - 211.5 KB] … created December 2012 Internet Citation: Background Quality Improvement Team Information Form

17. Introduction to the Quality Indicators Best Practices Tool (pdf file)
    patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4_combo_bestpracticescover.pdf
    June 05, 2016 - The best practices forms are not meant to replace validated guidelines. … Which QIs have best practices forms? … Best practices forms have been developed for all PSIs and PDIs for which there was sufficient evidence … Best practices forms exist for the following 14 PSIs: • PSI 03 Pressure Ulcer Rate • PSI 05 Retained … to be captured by one best practices form.

18. Getting Recognition for Your AHRQ-Funded Study | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/funding/grant-mgmt/recognition_ahrq-funded_study.html
    November 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Please use this PDF form  [153.4 KB] to submit the information below. … Contact  journalpublishing@ahrq.hhs.gov with any questions or assistance with this form. … The fillable PDF form linked above contains the following fields to submit information.   … This page cannot submit information, and is intended only to identify the information requested in the form

19. Auditing Your Briefings and Debriefings Process: Slide Presentation | Agency for Healthcare Research and Quality
    patientregistry.ahrq.gov/hai/tools/surgery/modules/implementation/audit-briefing-slides.html
    December 01, 2017 - Grant Application, Review & Award Process Grant Application Basics Application Forms … What forms and structures should be in place? … Image: Logistics section of briefing form: Who initiated briefing? Surgery attending. … INTRAOP Back of the form . Operating room nurse coordinates. … INTRAOP Back of the form . Operating room nurse coordinates.

20. Medication Management: Sample Process for Medication Management Strategy (pdf file)
    patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medication-mgmt-sample-process.pdf
    January 12, 2017 - Using the Medication List form, go through the prescription medications one by one: a. … Check whether the medication is expired and note that on the Medication List form. d. … Indicate on the Medication List form whether the patient is taking the medication as prescribed. … Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions