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81. Getting Recognition for Your AHRQ-Funded Study | Agency for Healthcare Research and Quality
    www.ahrq.gov/funding/grant-mgmt/recognition_ahrq-funded_study.html
    November 01, 2021 - 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

82. Background Quality Improvement Team Information Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/team-info-form.html
    July 01, 2023 - Background Quality Improvement Team Information Form AHRQ Safety Program for Perinatal

83. PBRN Registry Update Request Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/communities/pbrn/registry/register/update.html
    Update PBRN Registry Asterisk denotes required fields Enter your Email Address: Enter your PBRN ID: What would you like to do? Update Your PRBN Registry Information Inactivate Your PRBN Registry Information CAPTCH…

84. PowerPoint Presentation
    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK3_T5-Minimum_Criteria_for_3_Infections_Training_Slides-final.pptx
    October 01, 2016 - Nursing Staff Training on Importance and Use of SBAR Forms Nursing Home Antimicrobial Stewardship Guide … practitioners, and physician assistants about possible infections by using the suspected infection SBAR forms … Suspected Infection SBAR forms: I’ll explain these tools, how they are designed to work, and how they … Using the Suspected Infection SBAR form: We will discuss how to use each form specifically. … It includes a section that is a bit different from the UTI and SSTI SBAR forms.

85. Chapter 3. Data Collection and Analysis Using TRIPS | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man3.html
    December 01, 2017 - Forms and Training Materials (Appendix Contents) Appendix C. … Directions for completing the TRIPS form The first section of the TRIPS form is a basic log that … If a form of treatment was provided that is not listed on the form, the nurse should check "other" and … The nurse should sign the form and write in the date the form was completed. B. … Both restrictive and less restrictive forms of restraint should be recorded.

86. Telehealth | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/telehealth.html
    Tools AHRQ's Easy-to-Understand Telehealth Consent Form How to Obtain Consent for Telehealth Telehealth

87. Delivering Quality Reports in Print | Agency for Healthcare Research and Quality
    www.ahrq.gov/talkingquality/distribute/media/printed-report.html
    September 01, 2019 - Printed reports typically take the form of stand-alone documents. … Several quality reports designed for Medicaid audiences, for example, take the form of brief brochures

88. Agency for Healthcare Research and Quality (AHRQ) SOPS® Hospital Database Information and Instructions for Requesting SOPS Hospital-identifiable Data (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-instructions-requesting-identifiable-hsops-data.pdf
    January 01, 2024 - A completed Hospital-identifiable Research Abstract Form; 2. … All completed Research Abstract Forms are reviewed by Westat to ensure completeness and clarity, and … Requester Completes Forms Data Requester completes and submits: •Hospital-identifiable Research … Hospitals Provide Approval Hospitals review data requests and send Westat signed authorization forms … These forms are available on the AHRQ website (https://www.ahrq.gov/sops/databases/research- datasets.html

89. Research Datasets for CAHPS Surveys | Agency for Healthcare Research and Quality
    www.ahrq.gov/cahps/cahps-database/research-datasets/index.html
    February 01, 2025 - from the CAHPS Databases, please submit the following: CAHPS De-Identified Data Research Abstract Form … (PDF, 238 KB)—Please complete and submit this form to outline the proposed use of the data. … Sample CAHPS De-Identified Research Abstract Form (PDF, 255 KB)—Shows the form completed with sample … westat.com (Subject line: CAHPS De-Identified Data Request) Timeline All completed research abstract forms

90. Hospital Survey on Patient Safety Culture Database: Hospital-Identifiable Research Abstract Form (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-hsops-identifiable-conf-agreement.pdf
    January 01, 2024 - Hospital Survey on Patient Safety Culture Database: Hospital-Identifiable Research Abstract Form

91. AHRQ Request for Synthetic Healthcare Database for Research (SyH-DR) (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Application-062724.pdf
    April 02, 2025 - for Research (SyH-DR) SyH-DR Data Request 1 Please submit any questions, the completed request form … Synthetic Healthcare Database for Research (SyH-DR) INSTRUCTIONS FOR COMPLETING THE SYH-DR REQUEST FORM … Please reference the below terms and definitions as you complete the SyH-DR request form and DUA: • … The Data Requester should enter this name on the SyH-DR request form, and the Data Custodian and Data … SyH-DR Data Request 2 Please submit any questions, the completed request form, and signed DUA(s) to

92. Staff-Safety-Assessment (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/staff-safety-assessment.docx
    June 01, 2021 - AHRQ Safety Program for Improving Antibiotic Use Staff Safety Assessment PURPOSE OF THIS FORM: … All health care providers are encouraged to complete this form. … Consider asking all staff members to complete this form at least semiannually.

93. Appendix C: VTE Measurement and Tracking | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/vtguide/appc.html
    May 01, 2016 - VTE Prophylaxis Audit Form Designed To Evaluate a Sample of Inpatients Reviewer_______________ Patient … (Reverse/Reference Side of the Data Collection Form) DVT/PE Risk Level & Acceptable Choices Per Protocol … Description The audit form is designed for use on sampled active inpatients. … VTE Prophylaxis Audit Data Collection Form Site: UCSD Unit: 6U Unit Description: Medical floor Primary … Please review explanations and definitions on reverse of form.  

94. 8-Building-Core-Team (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/8-building-core-team.docx
    June 01, 2023 - AHRQ Safety Program for Improving Surgical Care and Recovery Core Team Form Building Your Core Team … Core Team Form 2 Core Team Form 2 Essential ISCR Team Leaders Role Responsibilities Potential … No. 23-0052 June 2023 AHRQ Safety Program for Improving Surgical Care and RecoveryCore Team Form 2 … AHRQ Safety Program for Improving Surgical Care and RecoveryCore Team Form 5 image2.jpg image1.png

95. Tool 2. Chart Audit Form and Instructions | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/tools/obesity/obpcp-tool2.html
    May 01, 2014 - Chart Audit Form and Instructions Previous Page Next Page Table of Contents Integrating … Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10. 

96. 3 Tk1 T5-Draft Policies And Procedures For The Antimicrobial Stewardship Program Final (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/3_TK1_T5-Draft_Policies_and_Procedures_for_the_Antimicrobial_Stewardship_Program_final.pdf
    October 01, 2016 - program intervention] DATE: [Date] Purpose and Scope This procedure covers the use of [name of form … Implement, Monitor, & Sustain a Program Toolkit 1/Tool 5 5 Sample Policy for Medical Record Referral Form … Nurses completely fill out the Medical Record Referral Form. … The form should be used to collect and convey information. … The form should be provided to the prescribing clinician and/or emergency department or hospital as

97. Implementation Guide for the Toolkit To Improve Antibiotic Use in Long-Term Care (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/ltc-implementation-guide.pdf
    June 01, 2021 - are directed at ASP leaders and cover the concept of using both technical and adaptive approaches to form … “Tracking and Measuring Antibiotic Use” includes an introduction to a comprehensive data collection form … and a link to the form, which will help track antibiotic use as well as orders for urine cultures and … Two forms are provided to assist with these discussions between ASPs and frontline staff: − The Learning … From Antibiotic-Associated Adverse Events form is similar to a root cause analysis form and can be

98. Create a Culture of Safety Around Antibiotic Prescribing | Agency for Healthcare Research and Quality
    www.ahrq.gov/antibiotic-use/long-term-care/safety/index.html
    January 01, 2024 - Antibiotic Use Commitment Poster (DOCX, 870 KB) Staff Safety Assessment Form  (DOCX, 330 KB) Implementation … Guide  (PDF, 402 KB) Learning From Antibiotic–Associated Adverse Events Form (DOCX, 227 KB) Gap … Analysis Tool  (DOCX, 382 KB) The Four Moments of Antibiotic Decision Making Form and Guide

99. Introducing a New Database for Users of the CAHPS Home and Community-Based Services (HCBS CAHPS) Survey-WOODWARD (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/hcbs-2021-webcast-technical-assistance.pdf
    January 01, 2021 - mailto:HCBSMeasures@lewin.com https://app.smartsheet.com/b/form/073b2dab4b824838b1a023134e92f473 https … ://app.smartsheet.com/b/form/598e60c379ba4e6b9583d5285244fb69 https://app.smartsheet.com/b/form/598e60c379ba4e6b9583d5285244fb69

100. Strategy 1: Working with Patients & Families as Advisors (Tool 13) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy1/Strat1_Tool_13_ShortTerm_HO_508.pdf
     April 02, 2025 - Patient and family advisors can work with you to help create or revise forms, letters, handouts, instructions … involvement of patient and family advisors, please fill out the Request for Patient and Family Advisors form … project, along with anticipated meeting times  Complete the Request for Patient and Family Advisors form … Guide to Patient and Family Engagement :: 3 Request for patient and family advisors Complete this form … Please submit this form to: [NOTE: Insert staff liaison name and contact information] Examples