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61. CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-140-section-5.8.pdf
    January 01, 2014 - CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) Table … symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form

62. Create a Culture of Safety Around Antibiotic Prescribing | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/antibiotic-use/long-term-care/safety/index.html
    January 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Antibiotic Use Commitment Poster (DOCX, 870 KB) Staff Safety Assessment Form  (DOCX, 330 KB) Implementation … Guide  (PDF, 402 KB) Learning From Antibiotic–Associated Adverse Events Form (DOCX, 227 KB) Gap … Analysis Tool  (DOCX, 382 KB) The Four Moments of Antibiotic Decision Making Form and Guide

63. CHIPRA 81: Section 2, Technical Specifications (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-81-pgh-7-section-2-tech-specs.pdf
    January 01, 2012 - Never – Rarely – Sometimes – Often - Always Healthy Pathways, Child Report Form Ped Global5 … Never – Rarely – Sometimes – Often - Always Healthy Pathways, Child Report Form Ped Global6 … Never – Rarely – Sometimes – Often - Always Healthy Pathways, Child Report Form Details of … To find the total raw score for a form with all questions answered, sum the values of the response to … Multiply this sum by the total number of items in the form.

64. Coaching Scenarios (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_scenarios.pdf
    April 24, 2017 - 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.

65. Develop and Improve Your Stewardship Program | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/antibiotic-use/acute-care/improve/index.html
    June 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Stewardship Bedside Nurse Collaborate With Microbiology Lab Team Antibiotic Review Form … All ASPs should be making daily interventions to improve antibiotic use; the Team Antibiotic Review Form … AHRQ Safety Program for Acute Care (PDF, 328 KB) Gap Analysis Tool (DOCX) Team Antibiotic Review Form

66. SNAC Submission Form. Section 2: Detailed Measure Specifications, Attachment 2: Chart Abstratcion Algorithm (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-2-attach-2.pdf
    February 02, 2017 - SNAC Submission Form. … Section 2: Detailed Measure Specifications, Attachment 2: Chart Abstratcion Algorithm SNAC Submission Form

67. TeamSTEPPS® 2.0 for Long-Term Care | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/teamstepps/longtermcare/index.html
    May 01, 2019 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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).

68. Teach-Back Tips (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/teach-back-tips-jobaid-final508.pdf
    April 04, 2018 - 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

69. Please bring ALL your medicines to your next appointment. (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptfactsheet.pdf
    November 27, 2017 - 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

70. Protection of Human Subjects | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/funding/policies/human-subjects/index.html
    June 01, 2022 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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 .

71. Toolkit 2. Common Suspected Infections: Communication and Decisionmaking for Four Infections | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit2-communications-and-decisionmaking.html
    November 01, 2016 - Grant Application, Review & Award Process Grant Application Basics Application Forms … This toolkit includes the following tools: A Medical Care Referral Form to document information for … Use the Medical Care Referral form. … 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

72. Creating A Handoff Checklist | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/teamstepps/officebasedcare/handouts/checklist.html
    November 01, 2015 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Creating A Handoff Checklist TeamSTEPPS Primary Care Version Participant Handouts Directions: Form … If your medical team members are present, form a group of your medical office team members and develop

73. Health Literacy Improvement Tools | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/health-literacy/improve/index.html
    March 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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

74. TeamSTEPPS® for Office-Based Care - Course Evaluation (pdf file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/handouts/courseeval.pdf
    December 02, 2015 - ........................ 1 2 3 Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form … ............................................ 1 2 3 Comments: Course Evaluation Form – 2 TeamSTEPPS … ...................... 1 2 3 Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form … Course Evaluation Form – 4 TeamSTEPPS for Office-Based Care TeamSTEPPS® for Office-Based Care … Additional Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form –

75. Plan-Do-Study-Act Worksheet, Directions, and Examples | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/health-literacy/improve/precautions/tool2b.html
    March 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 … Help With Medicines Poster Get Patient Feedback: Tool 17 Patient Portal Feedback Form Suggestion

76. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Issues Worksheet for Senior Executive Partnership (doc file)
    www.healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/worksheet.docx
    May 01, 2017 - Health care providers and senior leader(s) How to complete this form: Provide as much detail as possible … When to complete this form: It should be completed at least semiannually.

77. Implementation Guide for AHRQ's Making Informed Consent an Informed Choice Training Modules | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/health-literacy/professional-training/informed-choice/guide.html
    September 01, 2020 - Forms Complex consent forms not understandable to patients and families. … forms being used in your hospital. … Forms and Decision Aids X percent of informed consent forms will be understandable by culturally … want to track the percentage of informed consent forms assessed, the percentage of forms revised, and … Did anyone help you read the form?

78. Four Moments of Antibiotic Decision Making | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/antibiotic-use/long-term-care/four-moments/index.html
    August 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 … 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

79. Strategy 1: Working With Patients and Families as Advisors | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy1/index.html
    December 01, 2017 - Grant Application, Review & Award Process Grant Application Basics Application Forms … 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

80. AHRQ Tips for Grant Applicants | Agency for Healthcare Research and Quality
    www.healthcare411.ahrq.gov/funding/process/grant-app-basics/apptips.html
    July 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Funding Grant Application, Review & Award Process Grant Application Basics Application Forms … Revision Application (when applicable) 1 Specific Aims (Attachment 2 on PHS 398 Research Plan form … DP7 applications only 25 Program Plan (Attachment 2 on PHS 398 Research Training Program Plan form … a multi-component application) 1 Specific Aims For all Activity Codes that use an application form