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201. Please bring ALL your medicines to your next appointment. (Postcard) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptreminder-postcard.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

202. Chapter 5 | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/patients-families/consumer-exp/reporting/chapter5.html
     August 01, 2022 - Reporters will be asked to complete a standardized reporting form. … The form will assure users that confidential information protection is a top priority for the system. … The standardized reporting form will allow both structured and unstructured reporting. … Pilot testing will likely be important for finalizing the reporting form. … A "smart form" would be used for each of these options, allowing submitted information to be entered

203. 6-Gap-Analysis-Goal (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/6-gap-analysis-goal.docx
     June 01, 2023 - AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form Creating … The main purpose of this form is for your institution to see where you are starting from and plan ahead … Review the data collected in the Gap Analysis and Goal-Setting Form with your team. … AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form … AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form

204. Toolkit 2. Common Suspected Infections: Communication and Decisionmaking for Four Infections | Agency for Healthcare Research and Quality
     www.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit2-communications-and-decisionmaking.html
     November 01, 2016 - This toolkit includes the following tools: A Medical Care Referral Form to document information … Use the Medical Care Referral form. … The Medical Care Referral form facilitates communication between nurses and clinicians when a resident … The form documents information clinicians need for prescribing decisions and reflects evidence-based … Prescribing clinicians should also be trained to use order forms for treatment other than antibiotics

205. SOPS® Database Information and Instructions for Requesting De-identified SOPS Database Data (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-instructions-requesting-deidentified-sops-data.pdf
     January 01, 2024 - A completed De-identified Research Abstract Form and 2. A signed Data Release Agreement. … All completed Research Abstract Forms are reviewed by AHRQ and its contractor, Westat, in accordance … If there are concerns about a submitted Research Abstract Form raised during the review process, the … Data Requesters may make modifications and re-submit the Research Abstract Form for review. … obtaining de-identified SOPS data from the SOPS Database must submit a completed Research Abstract Form

206. Final Progress Report: Preventing/Managing C. Diff for Nursing Home Residents, Admissions, and Discharges (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/phillips-report.pdf
     January 01, 2024 - Aim 2 tested a special transfer form to be used by nursing homes and hospitals to identify individuals … The seven RN raters each returned eight completed PPERT forms for analysis, resulting in 56 PPERT … forms. … The study also scanned the PPERT forms and retained the hard copies for archiving purposes. … The interviews focused on each staff member’s experience implementing the transfer form.

207. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Sensemaking and Learn from Defects
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/sensemaking/sensemaking.pptx
     May 01, 2017 - Defects 2 CUSP and Sensemaking Tools1 CUSP Tools Sensemaking Tools Staff Safety Assessment Discovery Form … Safety Issues Worksheet Root Cause Analysis Learn From Defects Form Failure Mode and Effects Analysis … identify defects or failure - Staff Safety Assessment - Status of Safety Issues Worksheet - Discovery Form … Analysis - Probabilistic Risk Assessment Tools to examine defects or failures Learn From Defects Form … Causal Tree Worksheet Coding defects or failures Learn From Defects Form Eindhoven Model 4 AHRQ Safety

208. IV. References | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/crctoolkit/crctoolkit4.html
     April 01, 2018 - Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE

209. 3. Assessment Plan and Methodology | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/crcscreeningrpt/crcscreen3.html
     April 01, 2018 - The SEA form was undeliverable. … SEA Form The primary purpose of the Screening Eligibility Assessment (SEA) form was to be a source … The overall response rate was 27.9 percent (2,810 responses out of 10,063 forms mailed). … Although the central entity mailed the forms following the same protocol to all the practices, response … not receive an SEA form).

210. Creating a Safe Medicine List: Patient Information/Reminder Flyer (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-patient-flier-final508.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

211. Advantages and Disadvantages of Registries (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/registries-pros-cons.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

212. Teach-Back Tips (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/teach-back-tips-jobaid-final508.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

213. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/antibiotic-targets-slides.pptx
     June 01, 2021 - Using the Four Moments of Antibiotic Decision Making Form may help identify problems. … identify problems Review data collected on the Four Moments of Antibiotic Stewardship Decision Making Form … Collect and analyze data using the Monthly Data Collection Form Distribute the Antibiotic Side Effects … Staff Safety Assessment  Antibiotic Side Effects One-Pager Four Moments of Antibiotic Decision Making Form … Monthly Data Collection Form Identifying Targets 18 Disclaimer The findings and recommendations

214. Integrating Primary Care Practices and Community-based Resources to Manage Obesity | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/tools/obesity/index.html
     May 01, 2014 - Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10.  … Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10. 

215. Hospital Handoff to Nursing Home | Agency for Healthcare Research and Quality
     www.ahrq.gov/nursing-home/resources/hospital-handoff.html
     February 01, 2021 - The completed form provides key patient information to the nursing home and should travel with the resident

216. Protection of Human Subjects | Agency for Healthcare Research and Quality
     www.ahrq.gov/funding/policies/human-subjects/index.html
     June 01, 2022 - Posting Clinical Trial Informed Consent Form (45 CFR 46.116(h)) The revised Common Rule requires that … for any clinical trial conducted or supported by a Common Rule department or agency, one consent form … The consent form must have been used in enrolling participants in order to satisfy this new provision … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials . … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials .

217. Checklist: Creating a Medicine List When Patient Does NOT Bring Medicines (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-checklist-nomeds-final508.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

218. IVD Aspirin Use Measure Flow Chart (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/aspirin-flowchart.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

219. Please bring ALL your medicines to your next appointment. (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptfactsheet.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

220. Medication Management: Common Barriers to Medication Adherence (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medication-mgmt-common-barriers-card-4x6.pdf
     June 02, 2025 - 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 … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate