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61. PowerPoint Presentation (ppt file)
    www.talkingquality.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

62. CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) (pdf file)
    www.talkingquality.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.

63. Fillable Plan Do Study Act (PDSA) Tool for Health Care Quality Improvement (QI) | Agency for Healthcare Research and Quality
    www.talkingquality.ahrq.gov/evidencenow/tools/pdsa-form.html
    November 01, 2018 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Act (PDSA) Tool for Health Care Quality Improvement (QI) Resource: Plan Do Study Act (PDSA) Form … Using this form can be helpful to primary care practices following the Model for Improvement quality

64. CHIPRA 81: Section 2, Technical Specifications (pdf file)
    www.talkingquality.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.

65. CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) (pdf file)
    www.talkingquality.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

66. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Sensemaking and Learn from Defects
    www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/sensemaking/sensemaking.pptx
    May 01, 2017 - Defects 2 CUSP and Sensemaking Tools1 CUSP Tools Sensemaking Tools Staff Safety Assessment Discovery Form … Safety Issues Worksheet Root Cause Analysis Learn From Defects Form Failure Mode and Effects Analysis … identify defects or failure - Staff Safety Assessment - Status of Safety Issues Worksheet - Discovery Form … Analysis - Probabilistic Risk Assessment Tools to examine defects or failures Learn From Defects Form … Causal Tree Worksheet Coding defects or failures Learn From Defects Form Eindhoven Model 4 AHRQ Safety

67. Coaching Scenarios (pdf file)
    www.talkingquality.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.

68. SNAC Submission Form. Section 2: Detailed Measure Specifications, Attachment 2: Chart Abstratcion Algorithm (pdf file)
    www.talkingquality.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

69. Develop and Improve Your Stewardship Program | Agency for Healthcare Research and Quality
    www.talkingquality.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

70. TeamSTEPPS® 2.0 for Long-Term Care | Agency for Healthcare Research and Quality
    www.talkingquality.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).

71. Teach-Back Tips (pdf file)
    www.talkingquality.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

72. Please bring ALL your medicines to your next appointment. (pdf file)
    www.talkingquality.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

73. Toolkit 2. Common Suspected Infections: Communication and Decisionmaking for Four Infections | Agency for Healthcare Research and Quality
    www.talkingquality.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

74. Protection of Human Subjects | Agency for Healthcare Research and Quality
    www.talkingquality.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 .

75. TeamSTEPPS® for Office-Based Care - Course Evaluation (pdf file)
    www.talkingquality.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 –

76. Creating A Handoff Checklist | Agency for Healthcare Research and Quality
    www.talkingquality.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

77. How To Use the PEMAT To Assess a Material | Agency for Healthcare Research and Quality
    www.talkingquality.ahrq.gov/health-literacy/patient-education/pemat2.html
    November 01, 2020 - Grant Application, Review & Award Process Grant Application Basics Application Forms … If you use the PEMAT Auto-Scoring Form, a form that will automatically calculate PEMAT scores once you … The form is downloadable in Excel (235 KB) Step 1: Read through the PEMAT and User's Guide. … You may refer to the material at any time while you complete the form.

78. Health Literacy Improvement Tools | Agency for Healthcare Research and Quality
    www.talkingquality.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

79. Plan-Do-Study-Act Worksheet, Directions, and Examples | Agency for Healthcare Research and Quality
    www.talkingquality.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

80. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Issues Worksheet for Senior Executive Partnership (doc file)
    www.talkingquality.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.