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21. Community-Referral-Form (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/community-referral-form.docx
    March 01, 2024 - Community Referral Form: [Practice Name] Reason for Referral_________________________________ Name of … _____________________________________________________________________ Example Community Referral Form … Community Referral Form: City Medical Care Reason for Referral Education Classes Name of Program

22. Chart Abstraction Form (pdf file)
    www.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

23. 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

24. Pemat Form (xls file)
    www.talkingquality.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

25. 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

26. Pemat Form (xls file)
    pbrn.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

27. Pemat Form (xls file)
    pcmh.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

28. Pemat Form (xls file)
    ce.effectivehealthcare.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

29. Form I. Patient Consent Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/resources/resdesign-tool/tkformi.html
    August 01, 2016 - Definitions Form A. Site Visit/Conference Call Questions Form B. … Employee Focus Group Questions Form C. … Patient/Family Focus Group Consent Form Form F. Staff Process Flow Observation Form Form G. … Patient Process Flow Observation Form Form H. Staff Member Consent Form Form I. … I will get a copy of this consent form. Initial all the previous pages of consent form.

30. Disclosure Policy and Form (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/epc-disclosure-policy-form.pdf
    March 01, 2023 - Although the logistics of gathering COI disclosure forms may be delegated to a project manager, the … Although the logistics of gathering the COI disclosure forms may be delegated to a project manager, … The EPC should update Disclosure Forms for any individual whose involvement in the projects extends … The EPC should maintain the Disclosure Forms for 6 years past delivery of the final report. … The EPC should maintain the Disclosure Forms for 6 years past delivery of the final report.  

31. Hospital Commitment Form.
    hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/mn10.jsp
    August 01, 2014 - Hospital Commitment Form. … DATA VISUALIZATIONS DATA QUERY TOOLS Hospital Commitment Form … HOSPITAL COMMITMENT FORM MINNESOTA HOSPITAL ASSOCIATION AGENCY FOR HEALTHCARE RESEARCH AND QUALITY … ________________________________________________(Phone/Email) Please sign and return this form. … _____________________________________ Internet Citation: Hospital Commitment Form

32. HOSPITAL COMMITMENT FORM (pdf file)
    hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/mn10.pdf
    June 21, 2014 - HOSPITAL COMMITMENT FORM HOSPITAL COMMITMENT FORM MINNESOTA HOSPITAL ASSOCIATION AGENCY FOR … ________________________________________________(Phone/Email) Please sign and return this form.

33. Action-Plan-Form-Example (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form-example.docx
    August 25, 2023 - Action Plan Form Example My visit with: Dr.

34. TeamSTEPPS Training Evaluation Form (pdf file)
    www.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

35. TeamSTEPPS Coaching Feedback Form (pdf file)
    www.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

36. User Login Form
    pso.ahrq.gov/image-captcha-refresh/user_login_form
    {"status":1,"message":"","data":{"url":"\/image-captcha-generate\/10593\/1633360712","token":"mGkDXf655aZh2olfhiZLqm3erakHN8vTsMCOrw2EyuM","sid":"10593"}}

37. Form H. Staff Member Consent Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/resources/resdesign-tool/tkformh.html
    August 01, 2016 - Definitions Form A. Site Visit/Conference Call Questions Form B. … Employee Focus Group Questions Form C. … Patient/Family Focus Group Consent Form Form F. Staff Process Flow Observation Form Form G. … Patient Process Flow Observation Form Form H. Staff Member Consent Form Form I. … I will get a copy of this consent form. (Initial all the previous pages of the consent form).

38. EPC Methods feedback form (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/funding/contracts/epc-iv/15-epc-methods-feedback-form.docx
    January 31, 2022 - EPC Methods feedback form [Report Title]—Methods Guidance 1.

39. Team-Antibiotic-Review-Form (doc file)
    www.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.

40. Disclosure Policy and Form (pdf file)
    effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pdf/epc-rev-team-confidentiality-form.pdf
    September 01, 2018 - Disclosure Policy and Form EPC Review Team Agreement The EPC Program follows three principles … Disclosure Policy and Form PrintButton1: SignatureField1: TextField2: