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41. The Medical Home Index: Revised Short Form: Pediatric. Measuring the Organization and Delivery of Pediatric Primary Care for All Children, Youth, and Families (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/mhi-rsf.pdf
    May 29, 2013 - The Medical Home Index: Revised Short Form: Pediatric. … Index revised to create MHI-RSF 2012. 1 Medical Home Index-Revised Short Form … The MHI-Revised Short Form (MHI-RSF) is a subset of 14 items from the MHI. … Index revised to create MHI-RSF 2012. 2 Medical Home Index-Revised Short Form … __________ Email: _______________________________ Who took the lead in completing this form

42. Research Training Tools and Resources | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/funding/training-grants/tools.html
    July 01, 2021 - following: AHRQ Support for Dissertation Research Grants (R36): Transition to the SF424 (R and R) Form … These forms are available in PDF format. … to be completed annually by T32 programs, from the following links: Financial Status Report Long Form … /grants.nih.gov/grants/fsr_sf269_long.pdf ( Plugin Software Help ) Financial Status Report Short Form … These forms can be found at the following sites: Statement of Appointment Form (PHS 2271) http://grants.nih.gov

43. Help Patients Remember How and When to Take Their Medicine: Tool 16 | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/health-literacy/improve/precautions/tool16.html
    February 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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 … Medicine Reminder Form .

44. Sensemaking and Learn From Defects for Perinatal Safety | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/learn-from-defects-slides.html
    July 01, 2023 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Safety Issues Worksheet Root Cause Analysis Learn From Defects Form Failure Mode and Effects … Use the Staff Safety Assessment Form to first, identify clinical or operational problems that have or … Use this form to engage the senior executive to address the safety issues identified in the form. … Keep the project leader apprised of the information on this form.

45. Sample “Plan-Do-Study-Act” Form | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/pdsa-form.html
    June 01, 2017 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Tools Ambulatory Surgery Centers Toolkit Sections Sample “Plan-Do-Study-Act” Form … Telemedicine Universal ICU Decolonization Protocol Sample “Plan-Do-Study-Act” Form … Use this form to help you plan your introduction of visual management.  … 2017 Page originally created May 2017 Internet Citation: Sample “Plan-Do-Study-Act” Form

46. HRQ Safety Program for Perinatal Care: Labor and Delivery Unit Staff Safety Assessment (doc file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/assessment.docx
    May 01, 2017 - Who should complete this form: All L&D staff (clinical and nonclinical) How to complete this form: Provide … Submit your completed safety assessment form in the location designated by the unit safety coordinator … When to complete this form: All L&D staff should complete this form at least semiannually.

47. Forms and Electronic Applications | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/funding/process/app-forms/index.html
    November 01, 2015 - change from paper to electronic filing, the current PHS 398 application will be replaced by the Standard Form … Following this advice will ensure you have the latest forms and correct application package. … Research Grants Form/Application Instructions Description/Comments SF424 (R&R) (Word File, 26 … Fishers Lane Rockville, MD 20857 Phone: (301) 427-1447 Fax: (301) 427-1462 Fellowships Form … Kirschstein National Research Service Award Individual Fellowship Application Form ** to be used ONLY

48. Staff-Safety-Assessment (doc file)
    www.monahrq.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.

49. Sample “Plan-Do-Study-Act” Form | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/huddles-pdsa-form.html
    June 01, 2017 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Tools Ambulatory Surgery Centers Toolkit Sections Sample “Plan-Do-Study-Act” Form … Telemedicine Universal ICU Decolonization Protocol Sample “Plan-Do-Study-Act” Form … Use this form to help you plan your introduction of daily huddles. … 2017 Page originally created May 2017 Internet Citation: Sample “Plan-Do-Study-Act” Form

50. Introduction to the Quality Indicators Best Practices Tool (pdf file)
    www.monahrq.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.

51. Getting Recognition for Your AHRQ-Funded Study | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/funding/grant-mgmt/recognition_ahrq-funded_study.html
    November 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Please use this PDF form  [153.4 KB] to submit the information below. … Contact  journalpublishing@ahrq.hhs.gov with any questions or assistance with this form. … The fillable PDF form linked above contains the following fields to submit information.   … This page cannot submit information, and is intended only to identify the information requested in the form

52. TeamSTEPPS - Table of Contents (pdf file)
    www.monahrq.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

53. Address Language Differences: Tool 9 | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/health-literacy/improve/precautions/tool9.html
    February 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 … Failing to use acceptable forms of language access services can expose a practice to liability. … Decide what to translate, such as signs, forms, instructions, appointment reminders, and patient surveys

54. Labor and Delivery Unit Staff Safety Assessment | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/assessment.html
    July 01, 2023 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Who should complete this form: All L&D staff (clinical and nonclinical) How to complete this form: … Submit your completed safety assessment form in the location designated by the unit safety coordinator … When to complete this form: All L&D staff should complete this form at least semiannually.

55. TeamSTEPPS 2.0: Module 9 | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/teamstepps/instructor/fundamentals/module9/coachscenarios.html
    March 01, 2014 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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.

56. TeamSTEPPS 2.0: Coaching Scenario 1 (pdf file)
    www.monahrq.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.

57. Research Datasets for CAHPS Surveys | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/cahps/cahps-database/research-datasets/index.html
    January 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … from the CAHPS Databases, please submit the following: CAHPS De-Identified Data Research Abstract Form … (PDF, 230 KB)—Please complete and submit this form to outline the proposed use of the data. … Sample CAHPS De-Identified Research Abstract Form (PDF, 247 KB)—Shows the form completed with sample … westat.com (Subject line: CAHPS De-Identified Data Request) Timeline All completed research abstract forms

58. AHRQ Safety Program for Perinatal Care: Background Quality Improvement Team Information Form (doc file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/team-info-form.docx
    May 01, 2017 - AHRQ Safety Program for Perinatal Care: Background Quality Improvement Team Information Form AHRQ Safety … Program for Perinatal Care Background Quality Improvement Team Information Form Who should use this

59. PowerPoint Presentation (ppt file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK2_T4-Common_Suspected_Infections_Tools_to_Improve_Communication_and_Decision_Making.ppt
    May 01, 2014 - * Evidence-based Communication Between Nurses and Prescribers: Using a Medical Care Referral Form … (MCRF) * Medical Care Referral Form (MCRF) Designed to facilitate evidence-based communication … Ideally, all long-term care facility residents should have a POLST accepted form on the chart and have … The form is on bright pink paper so it can be easily identified in case of an emergency. … A physician, physician assistant, or nurse practitioner must complete the POLST accepted form based on

60. CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/cpcf.pdf
    December 31, 2015 - CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) CHIPRA … Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) The CHIPRA Pediatric … Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) was approved by the Office … The form also requests identification of the limitations of the measure being submitted. … Data Source [Online form will have radio buttons here] 1.