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pcmh.ahrq.gov/health-literacy/improve/index.html
March 01, 2024 - AHRQ's Easy-to-Understand Telehealth Consent Form
AHRQ's telehealth consent resources include a … sample telehealth consent form (Word, 27 KB) that is easy to understand and how-to guidance for clinicians … The consent form includes provisions for healthcare providers that have curtailed in-person visits due
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pcmh.ahrq.gov/teamstepps/instructor/fundamentals/module12/igpracticeteach.html
March 01, 2014 - Subsections:
Practice Teaching Session
Module Time: 4 hours
Materials:
Teaching Feedback Form … feedback from me (and/or any other Master Trainers present for the session) on the Teaching Feedback Form … After Module 1 is complete, have participants complete the Teaching Feedback Form. … Time: 4 hours
Materials:
Teaching Feedback Form
Return to Contents Return to Index
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pcmh.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.
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4_combo_bestpracticescover.pdf
June 05, 2016 - The best practices forms are not meant to replace validated guidelines. … Which QIs have best practices forms? … Best practices forms have been developed for all PSIs
and PDIs for which there was sufficient evidence … Best practices forms exist for the following 14 PSIs:
• PSI 03 Pressure Ulcer Rate
• PSI 05 Retained … to be captured by one best
practices form.
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pcmh.ahrq.gov/health-literacy/research/tools/index.html
December 01, 2022 - Assessment of Health Literacy–Spanish and English
Rapid Estimate of Adult Literacy in Medicine–Short Form … Only the Rapid Estimate of Adult Literacy in Medicine–Short Form was developed to identify patients with … Pub Med ID (PMID) : 20500222 [Full text available in PubMedCentral]
Contents:
SAHL-S Test Form & … User’s Guide (Select for PDF [36.33 KB] ) SAHL-E Test Form & User’s Guide (Select for PDF [53.04 … Development and validation of a short-form, rapid estimate of adult literacy in medicine.
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pcmh.ahrq.gov/hai/cusp/modules/identify/identify.html
December 01, 2012 - defects or failure
Staff Safety Assessment
Status of Safety Issues Worksheet
Discovery Form … Causal Tree Worksheet
Coding defects or errors
Learn From Defects Form
Eindhoven Model
Return … The conversation is the mechanism that combines that knowledge into a new, more understandable form for … Engage the senior executive in addressing the safety issues identified on the form.
Step 2. … Keep the project leader apprised of the information on this form.
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/contents.pdf
March 21, 2014 - Management: How to
Achieve a Culture of Safety
Module 9: Coaching Workshop
• Coaching Feedback Form … • Coaching Scenarios
• Coaching Self-Assessment Form
Module 10: Measurement
• Evaluating TeamSTEPPS … Workshop
• TeamSTEPPS Implementation Guide
Module 12: Practice Teaching Session
• Teaching Feedback Form … Planning Workshop
Module 12: Practice Teaching Session
TAB F MEASURES
Sample Course Evaluation Form
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pcmh.ahrq.gov/antibiotic-use/long-term-care/four-moments/index.html
August 01, 2021 - Long-Term Care Toolkit
Four Moments
Four Moments Posters
Four Moments Review Form … The Four Moments of Antibiotic Decision Making Review Form and Guide
The Antibiotic Stewardship Team … is encouraged to use Four Moments of Antibiotic Decision Making Form to review 5–10 residents each
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pcmh.ahrq.gov/funding/policies/human-subjects/index.html
June 01, 2022 - Posting Clinical Trial Informed Consent Form (45 CFR 46.116(h))
The revised Common Rule requires that … for any clinical trial conducted or supported by a Common Rule department or agency, one consent form … The consent form must have been used in enrolling participants in order to satisfy this new provision … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials . … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials .
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pcmh.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit2-communications-and-decisionmaking.html
November 01, 2016 - This toolkit includes the following tools:
A Medical Care Referral Form to document information for … Use the Medical Care Referral form. … The Medical Care Referral form facilitates communication between nurses and clinicians when a resident … The form documents information clinicians need for prescribing decisions and reflects evidence-based … Prescribing clinicians should also be trained to use order forms for treatment other than antibiotics
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medication-mgmt-sample-process.pdf
January 12, 2017 - Using the Medication List form, go through the prescription medications one by one:
a. … Check whether the medication is expired and note that on the Medication List form.
d. … Indicate on the Medication List form whether the patient is taking the
medication as prescribed. … Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions
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pcmh.ahrq.gov/funding/grant-mgmt/noncomp.html
November 01, 2015 - after the first twelve months requires the annual submission of a financial assistance request in the form … Contents
Forms Application Contents Date of Submission Where to Send the Application Inquiries
Forms … /2590/2590.htm , including:
Budget, as described in Section 2.2, including separate budget pages (form … Budget justification, as appropriate, on form page 3 (see item 2 below). … Progress report summary (form page 5).
Checklist (form page 6).
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module9/coachscenarios.pdf
March 20, 2014 - Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form.
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pcmh.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy1/index.html
December 01, 2017 - Word version - 2.62 MB ; PDF version - 171.61 KB ]
Patient and Family Advisor Application Form—Form … Microsoft Word version - 462.55 KB ; PDF version - 214.81 KB ]
My Participation Interests - Form … session that contains suggestions for ways to incorporate advisors on short-term projects along with a form
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pcmh.ahrq.gov/teamstepps/longtermcare/index.html
May 01, 2019 - Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB). … Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB). … Practice Teaching Feedback Form (PDF; 1 page; 119 KB).
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pcmh.ahrq.gov/funding/grant-mgmt/closeout.html
December 01, 2022 - Use Standard Form 425, form and instructions available online at: https://grants.nih.gov/grants/forms … Use Form HHS 568, which is available online at: http://grants.nih.gov/grants/hhs568.pdf ( Plugin Software
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pcmh.ahrq.gov/sites/default/files/wysiwyg/patient-safety/patient-prep-card.pdf
November 30, 2016 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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pcmh.ahrq.gov/antibiotic-use/acute-care/safety/index.html
June 01, 2021 - Poster (DOCX)
Antibiotic Time Out Tool (DOCX)
Identifying Antibiotic–Associated Adverse Events Form … (DOCX)
Learning From Antibiotic–Associated Adverse Events Form (DOCX)
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pcmh.ahrq.gov/health-literacy/improve/precautions/tool2b.html
March 01, 2024 - Health Literacy Universal Precautions Toolkit, 3rd Edition
Introduction
Quick Start Guide
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 … Action Plan
Help Patients Remember How and When to Take Their Medicine: Tool 16
Medicine Reminder Form … Help With Medicines Poster
Get Patient Feedback: Tool 17
Patient Portal Feedback Form
Suggestion
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pcmh.ahrq.gov/funding/process/grant-app-basics/apptips.html
July 01, 2021 - Funding
Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Research Education Program Plan (uploaded via the Research Strategy on PHS 398 Research Plan form … applications only
25
Program Plan (Attachment 2 on PHS 398 Research Training Program Plan form … multi-component application)
1
Specific Aims
For all Activity Codes that use an application form … For Activity Codes R42 , R44 , SB1 , UT1 , U44 , UB1 (Attachment 7 on SBIR/STTR Information form