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1. Pemat Form (xls file)
   www.qualitymeasures.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. Pemat Form (xls file)
   www.qualitymeasures.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

3. Chart Abstraction Form (pdf file)
   www.qualitymeasures.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

4. TeamSTEPPS Training Evaluation Form (pdf file)
   www.qualitymeasures.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

5. TeamSTEPPS Coaching Feedback Form (pdf file)
   www.qualitymeasures.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

6. ASTD Coaching Self-Assessment Form (pdf file)
   www.qualitymeasures.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

7. Team-Antibiotic-Review-Form (doc file)
   www.qualitymeasures.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.

8. ENSW FIELD NOTE FORM (pdf file)
   www.qualitymeasures.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

9. Easy-To-Understand-Telehealth-Consent-Form (doc file)
   www.qualitymeasures.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.

10. Completion Guide_Team Antibiotic Review Form (pdf file)
    www.qualitymeasures.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

11. Practice Asthma Data Collection Form (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/asthma-data-collection-form.pdf
    May 21, 2019 - Practice Asthma Data Collection Form __________________________________ _________________________ … ______________________________________ Confidential Page 1 of 8 Practice Asthma Data Collection Form … IMPLEMENT 05/21/2019 projectredcap.org https://projectredcap.org Practice Asthma Data Collection Form

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

13. Plan Do Study Act (PDSA) Form (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/pdsa-form.pdf
    February 11, 2015 - Plan Do Study Act (PDSA) Form PLAN DO STUDY ACT (PDSA) FORM Cycle #: Start Date: End Date: Project … July 24, 2014 Credit to IHI Open School for Health Professionals for original form. … July 24, 2014 Credit to IHI Open School for Health Professionals for original form.

14. Team Antibiotic Review Form | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

15. The Four Moments of Antibiotic Decision Making Form | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/antibiotic-use/long-term-care/four-moments/review-form.html
    June 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Long-Term Care Toolkit Four Moments Four Moments Posters Four Moments Review Form … Learn Best Practices The Four Moments of Antibiotic Decision Making Form … The Four Moments of Antibiotic Decision Making Form  (PDF, 319 KB) Completion Guide for the Four Moments … of Antibiotic Decision Making Form  (PDF, 265.3 KB) Page last reviewed

16. EvidenceNOW: Implementation Tracking Form | Agency for Healthcare Research and Quality
    www.qualitymeasures.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

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

18. Choosing an Intervention and Measuring Change | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/antibiotic-use/long-term-care/improve/intervention.html
    June 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … The Staff Safety Assessment Form and the Learning from Antibiotic-Associated Adverse Events Form … The Monthly Data Collection Form can help track antibiotic use, urine cultures, and Clostridioides … Staff Safety Assessment Form (DOCX, 330.3 KB) Learning From Antibiotic-Associated Adverse Events Form … (DOCX, 226.7 KB) Intervention Worksheet  (PDF, 157.4 KB) Monthly Data Collection Form (XLSX, 345.5

19. Candidate Measure Submission Form (CPCF) | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/policymakers/chipra/cpcf-form1.html
    July 01, 2018 - Grant Application, Review & Award Process Grant Application Basics Application Forms … SHARE: Candidate Measure Submission Form … Program (PQMP) The CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form … Data Source [Online form will have radio buttons here] 1. … Page originally created March 2013 Internet Citation: Candidate Measure Submission Form

20. SOPS® Database De-Identified Data Research Abstract Form (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/Example-SOPS-De-IdentifiedDataForm.pdf
    June 01, 2023 - SOPS® Database De-Identified Data Research Abstract Form Agency for Healthcare Research and Quality … (AHRQ) SOPS® Database De-Identified Data Research Abstract Form EXAMPLE OF A COMPLETED FORM This … completed abstract presents an example of how to complete this form. … Date Research Abstract Form Completed Provide the date you are submitting the Research Abstract Form … Data Research Abstract Form Instructions