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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/checklist
January 01, 2022 - 491KB)
Workflow Assessment Checklist ( PDF , 119KB)
Description
A checklist is a form … DESIGN A FORM with clearly labeled categories and sufficient room for data entry. … Make sure the form is easy to read and use.
4. PERFORM DATA COLLECTION during the agreed period. … Disadvantages
Checklist forms are usually specific to a particular situation.
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digital.ahrq.gov/sites/default/files/docs/implementation/Gorman508c.pdf
December 26, 2012 - to clinic
Clinic RN receives fax (rehab form), checks EHR2
MD gives form to clinic RN
Adds Rx … to NH
MD writes Rx on form
Form given to MD
Rehab center, clinic, pharmacy lists reconciled … to clinic
Clinic RN receives fax (rehab form), checks EHR2
MD gives form to clinic RN
Adds Rx … to NH
MD writes Rx on form
Form given to MD
Rehab center, clinic, pharmacy lists reconciled … to clinic
Clinic RN receives fax (rehab form), checks EHR2
MD gives form to clinic RN
Adds Rx
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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_5_ADE_and_Near_Miss_Incident_Classification_Form.pdf
September 30, 2009 - DATAFORM 5 ADE and Near Miss Incident Classification Form
DATAFORM 5
ADE and Near Miss Incident … Classification Form
1. … printed template
Page 2 of 3
6/6/05
Dataform 5: ADE and Near Miss Incident Classification Form … No
Page 3 of 3
6/6/05
Dataform 5: ADE and Near Miss Incident Classification Form Version 5.0 … DATAFORM 5
ADE and Near Miss Incident Classification Form
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digital.ahrq.gov/principal-investigator/friedman-charles
January 01, 2022 - Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form
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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_3_Medication_Error_and_Near_Miss_Classification_Form.pdf
September 30, 2009 - DATAFORM 3 Medication Error and Near Miss Classification Form
WBD
DATAFORM 3
Medication Error … and Near Miss
Classification Form
1. … Research and Practice 5/27/05
Dataform 3: Medication Error and Near Miss Classification Form … 2.02 Underdose
2.03 Dose omitted (from order/when dispensed)
2.04 Dose units omitted
2.05 Dose form … Research and Practice 5/27/05
Dataform 3: Medication Error and Near Miss Classification Form
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digital.ahrq.gov/ahrq-funded-projects/statewide-implementation-electronic-health-records
January 01, 2022 - ADE Incident Identification Form
Description:
This form identifies an adverse drug … ADE and Near Miss Incident Classification Form
Description:
This form is used to … Implementation of Electronic Health Records
Document Type:
Data Collection Form … Chart Review Form
Description:
This is a chart review form for an … form for an adverse drug event study.
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digital.ahrq.gov/health-it-tools-and-resources/pediatric-resources/pediatric-documentation-templates/asthma-action-plan
January 01, 2022 - This template exists as a form paragraph which is inserted into the patient’s note in his or her electronic … In its current form, it is meant to be used during a visit to specifically review and/or develop a patient … This web site includes a view of the form paragraph and directions for use.
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digital.ahrq.gov/document-type/informed-consent-document
January 01, 2022 - Document
Focus Group Consent Form … (Spanish)
Description
Example consent form used in an AHRQ-funded project … The form is in Spanish. … at Memorial Hospital of RI (Brown University)
Description
Example consent form
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digital.ahrq.gov/ahrq-funded-projects/evaluating-smart-forms-and-quality-dashboards-electronic-health-record-ehr-6
January 01, 2022 - User interface accelerators for clinical documentation in Smart Form. … User interface accelerators for clinical documentation in Smart Form. … Principal Investigator
Middleton, Blackford
Project Name
Evaluating Smart Forms
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digital.ahrq.gov/ahrq-funded-projects/patient-centered-informatics-system-enhance-health-care-rural-communities-0
January 01, 2022 - Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings. … Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings.
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digital.ahrq.gov/principal-investigator/ziemer-david-c
January 01, 2022 - Medication reconciliation: comparing a customized medication history form … to a standard medication form in a specialty clinic (CAMPII 2). … Medication reconciliation: comparing a customized medication history form to a standard medication form
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digital.ahrq.gov/ahrq-funded-projects/evaluating-smart-forms-and-quality-dashboards-electronic-health-record-ehr-7
January 01, 2022 - Can a "Smart Form" increase physicians' satisfactions with managing patient health behavior risks? … Can a "Smart Form" increase physicians' satisfactions with managing patient health behavior risks? … Principal Investigator
Middleton, Blackford
Project Name
Evaluating Smart Forms
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digital.ahrq.gov/sites/default/files/docs/library/12_BlueButtonInitiative.asp.html
April 24, 2013 - The new process will require the requestor to: Obtain the appropriate order form (either PUF or LDS) … from the CMS website; Complete the order form with the exception of the Agency Tracking ID which will … By completing the PUF/LDS order form, you will be provided with a total cost. … This tracking ID must be recorded on your PUF/LDS order form prior to submission to CMS. … Once you have recorded your Agency Tracking ID onto your order form, submit the electronic order form
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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_4_ADE_Incident_Identification_Form.pdf
September 30, 2009 - ADE Incident Identification Formatory Pedi Med Study
DATAFORM 4
ADE Incident Identification Form … Excellence for Patient Safety Research and Practice 5/27/05
Dataform 4: ADE Incident Identification Form … 5/27/05
Dataform 4: ADE Incident Identification Form Version 0.8
error? … Unknown (STOP, form is complete)
17. … Version 0.8
DATAFORM 4
ADE Incident Identification Form
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digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives-search
January 30, 2008 - The documents include example data collection forms, logging tools, and checklists among many others. … 10 20 40 60 100 - All -
Search
ADE and Near Miss Incident Classification Form … Description:
This form is used to classify ADEs and near misses. … Description:
This form identifies an adverse drug event using data reported by a clinician … :
This is a chart review form for an adverse drug event (ADE) study.
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digital.ahrq.gov/sites/default/files/docs/resource/C2_Process_Guide_Standard.pdf
June 11, 2009 - Fax Cynthia Scheideman-Miller the following forms to (405) 713-4992
(white multi-page form) from … Completed
(white multi-page form)
Patient Enrollment Form
4. … Cynthia Scheideman-Miller will:
(blue form)
a. … Fax Patient Information Form and Enrollment Form to Consultant
ENROLLMENT:
1. … (tan form) in 72 hours, preferably prior to the first consult.
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digital.ahrq.gov/ahrq-funded-projects/achieving-individualized-precision-prevention-ipp-through-scalable
January 01, 2022 - Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form
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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_1_Prescription_Screening_Form.pdf
September 30, 2009 - of Excellence for Patient Safety Research and Practice 1/26/08
Dataform 1: Prescription Screening Form … Version 0.10
DATAFORM 1
Prescription Screening Form
1. … Antihistamine (all forms)
12. Antihypertensive
13. Antineoplastic
14. … Antiviral (all forms)
18. Bronchodilator (inhaled)
19. Bronchodilator (oral)
20. … Version 0.10
DATAFORM 1
Prescription Screening Form
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digital.ahrq.gov/health-it-tools-and-resources/health-it-costs-and-benefits-database/changing-medical-group-behaviors
August 01, 2006 - an electronic anesthesia record-keeping system would enhance completion rates of quality assurance forms … after notifying all anesthesia personnel about departmental policy regarding QA documentation, the QA form … Strategy: initial educational notification regarding QA followed one month later by integration of the QA form … one-time individual feedback, followed by 3 months of group completion reporting along with revised QA form … Rates of reporting of complications was associated with increased QA form completion.
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digital.ahrq.gov/sites/default/files/docs/page/2006Muller_052411comp.pdf
May 26, 2011 - standardized patient
medication list to be used in all hospitals
across the metropolitan area
Two forms … discharge
– Wallet size for patient to carry with him/her
An Idea Was Born
Providence had developed a form … color of sheet, adjusted wording
Area for each system to personalize with their
logo
Full Page Form … systems for group
learning
Challenges
Coordination of large group – scheduling
Advertising the form … Improve Communication
Support
Project Summary
An Idea Was Born
Membership
Process
Full Page Form