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1. Communication-Observation-Form (doc file)
   www.cpsi.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.

2. Action-Plan-Form (doc file)
   www.cpsi.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

3. Pemat Form (xls file)
   www.cpsi.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

4. Self-Assessment Form (pdf file)
   www.cpsi.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

5. Coaching Feedback Form (pdf file)
   www.cpsi.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

6. ENSW FIELD NOTE FORM (pdf file)
   www.cpsi.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/intervention-tracking-notes-sw.pdf
   July 19, 2018 - ENSW FIELD NOTE FORM 1 ENSW FIELD NOTE FORM 1. … You may upload a file (e.g., agendas, documents, forms, tools, or other notes or minutes) Facilitator

7. Team-Antibiotic-Review-Form (doc file)
   www.cpsi.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/team-antibiotic-review-form.docx

8. Easy-To-Understand-Telehealth-Consent-Form (doc file)
   www.cpsi.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.

9. AHRQ’s Easy-to-Understand Telehealth Consent Form | Agency for Healthcare Research and Quality
   www.cpsi.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.

10. Team Antibiotic Review Form | Agency for Healthcare Research and Quality
    www.cpsi.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

11. Communication Observation Form | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/health-literacy/improve/precautions/tool4c.html
    March 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Health Literacy Health Literacy Improvement Tools Communication Observation Form … Health Literacy Universal Precautions Toolkit, 3rd Edition Communication Observation 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

12. SAHL-E Test Form and User's Guide (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/literacy/sahl-e-form-user-guide.pdf
    December 18, 2014 - SAHL-E Test Form and User's Guide The 18 items of SAHL-E, ordered according to item difficulty (keys

13. SAHL-S Test Form and User Guide (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/literacy/sahl-s-form-user-guide.pdf
    December 18, 2014 - SAHL-S Test Form and User Guide The 18 items of SAHL-S, ordered according to item difficulty (keys

14. EvidenceNOW: Implementation Tracking Form | Agency for Healthcare Research and Quality
    www.cpsi.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

15. EvidenceNOW: Intervention Tracking Field Note Form | Agency for Healthcare Research and Quality
    www.cpsi.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

16. Inclusive Language for Intake Forms | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/health-literacy/improve/precautions/tool11h.html
    March 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Health Literacy Universal Precautions Toolkit, 3rd Edition Inclusive Language for Intake Forms … Key Strategies for Clear Communication Communication Self-Assessment Communication Observation Form … Checkbox Alternatives Checkboxes are commonly used in forms that are completed electronically. … Even on paper forms, checkboxes make data entry easier.

17. Facilitator Guide | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care-2/facilitator-guide.html
    July 01, 2023 - Grant Application, Review & Award Process Grant Application Basics Application Forms … In addition are links to two TeamSTEPPS documents, the coaching self-assessment form and the coaching … feedback form. … The coaching self-assessment form and feedback form are tools for self-improvement. … The feedback form can guide coaches on how to deliver feedback more effectively.

18. How to Obtain Consent for Telehealth | Agency for Healthcare Research and Quality
    www.cpsi.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.

19. Toolkit 1. Suspected UTI SBAR Toolkit | Agency for Healthcare Research and Quality
    www.cpsi.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.

20. My Action Plan | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/health-literacy/improve/precautions/tool15a.html
    March 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Key Strategies for Clear Communication Communication Self-Assessment Communication Observation Form … Insurance Release of Medical Information Appointment Reminder Letter Inclusive Language for Intake Forms … is available in Word (14 KB) as well as an  Action Plan Form Example (17 KB). … Ask more about specific details and record these details on the action plan form (what, how much, when