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www.innovations.ahrq.gov/sites/default/files/wysiwyg/chsp/compendium/2018-hospital-linkage-techdoc-appb.pdf
January 01, 2018 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
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www.innovations.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/mhi-rsf.html
May 01, 2013 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Demonstration Grant Program
What We Learned
The Medical Home Index: Revised Short Form … SHARE:
The Medical Home Index: Revised Short Form … The MHI-Revised Short Form (MHI-RSF) is a subset of 14 items from the MHI. … Name (if different than the person who completed this form): ___________________________ Title/Position
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/observation/observation-component-kit.docx
May 01, 2017 - · Keep your maintenance checklist observation forms in a folder or binder, in date order, so you can … Preparation
1
Can you use a surgical safety checklist form to summarize three procedure segments? … Example
Here is an example of an observation form tested at an ambulatory surgical center in April 2016 … Example Observation Form
Key:
ID: Identity
DOB: Date of birth
CRNA: Certified registered nurse anesthetist … The observation form can be posted on your visual management board.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/aspirin-algorithm.pdf
December 14, 2015 - Page does not require timed responses
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-2-attachment-3.pdf
January 17, 2017 - Measure 1, Section 2, Attachment 2
SNAC Submission Form Measure 1: Accurate ADHD Diagnosis
Section … into
record
Initial evaluation or report of
feedback from initial
evaluation
SNAC Submission Form … Note or
scanned
Rating Scale or initial
evaluation report
SNAC Submission Form Measure 1: Accurate
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-6-attachment-2.pdf
January 17, 2017 - Measure 1, Section 6, Attachment 2
SNAC Submission Form … consider adding exceptions (AMA-PCPI Specifications Staff)
Page 1 of 3
SNAC Submission Form … medical home setting (The Center for Advanced Pediatrics)
Page 2 of 3
SNAC Submission Form
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-6-attach-2.pdf
February 02, 2017 - ADHD Summary of Public Comments
SNAC Submission Form … consider adding exceptions (AMA-PCPI Specifications Staff)
Page 1 of 3
SNAC Submission Form … medical home setting (The Center for Advanced Pediatrics)
Page 2 of 3
SNAC Submission Form
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/chsp/compendium/2018-hospital-linkage-techdoc-appa.pdf
January 01, 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
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Rule Name Status Description
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www.innovations.ahrq.gov/pqmp/measures/tobacco-use.html
August 01, 2021 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … (PDF, 82 KB) NCINQ Tobacco Use and Help Specifications—Pop (PDF, 88 KB) NCINQ Tobacco Use and Help Form … (PDF, 697 KB) NCINQ Tobacco Use and Help Form—References (PDF, 18 KB) Materials Written Statement
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www.innovations.ahrq.gov/funding/grant-mgmt/closeout.html
December 01, 2022 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … 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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www.innovations.ahrq.gov/teamstepps/officebasedcare/module10/office_msmt-ig.html
September 01, 2015 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Reactions —TeamSTEPPS for Office-Based Care Course Evaluation Form. … If you plan to use a course evaluation form for continuing education credit purposes, please check with … This form captures both affective and instrumentality reactions. … Patient Safety Culture has an accompanying toolkit that contains the following materials:
Survey forms
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/CHIPRA0087-NCINQSexualActivityStatusForm.pdf
February 06, 2012 - Attachment A: CHIPRA Pediatric Quality Measures Proram (PQMP) Candidate Measure Submission Form (CPCF … Attachment A: CHIPRA Pediatric Quality Measures Program (PQMP) Candidate
Measure Submission Form … complete a specific field. << >> indicates the name of a text field in the online version
of this form … . + indicates an upload field in the online version of this form. … Data Source [Online form will have radio buttons]
a.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-8-attach-1.pdf
February 02, 2017 - Section 8: Feasibility, Attachment 1: Preliminary Results: Performance Rates
SNAC Submission Form … Language
English 52 89.66% 7 87.50%
Spanish 6 10.34% 1 12.50%
SNAC Submission Form
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/cholesterol-lipid-algorithm.pdf
December 14, 2015 - 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
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Rule Name Status Description
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-5-attach-1.pdf
January 01, 2009 - Section 5: Evidence, Attachment 1: AAP Guideline Evidence
SNAC Submission Form ADHD Measure 2: Behavior … SNAC Submission Form ADHD Measure 2: Behavior Therapy
Section 5: Evidence
Attachment 1: AAP Guideline … SNAC Submission Form ADHD Measure 2: Behavior Therapy
Section 5: Evidence
Attachment 1: AAP Guideline … • These programs typically run in the form of group parent training programs, and although not always … was limited to preschool-aged children who had moderate to severe dysfunction;
SNAC Submission Form
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www.innovations.ahrq.gov/teamstepps/instructor/fundamentals/module10/igmeasure.html
March 01, 2014 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Reactions —TeamSTEPPS Course Evaluation Form. … Return to Contents
Reactions: TeamSTEPPS Course Evaluation Form
Say:
Participant reactions … This form captures both affective and instrumentality reactions. … patient safety culture has an accompanying toolkit that contains the following materials:
Survey forms
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www.innovations.ahrq.gov/teamstepps/instructor/printver/index.html
March 01, 2014 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … PDF File , 308 KB)
Combat Care ( PDF File , 265 KB)
Measurement Tools:
Sample Course Evaluation Form … Instructor's Guide ( PDF File , 465 KB)
Classroom Slides ( PowerPoint® File , 1.47 MB)
Coaching Feedback Form … Instructor's Guide ( PDF File , 147 KB)
Classroom Slides ( PowerPoint® File , 455 KB)
Teaching Feedback Form
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-8-attachment-1.pdf
January 17, 2017 - Measure 1, Section 8, Attachment 1
SNAC Submission Form … 20 100.00% 35.00% 14.10% 55.90%
Site 2 38 32 84.21% 71.88% 56.30% 87.45%
SNAC Submission Form
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/mhi-rsf.docx
March 25, 2009 - THE MEDICAL HOME INDEX:
Medical Home Index-Revised Short Form (MHI-RSF) for the National Evaluation … The Medical Home Index: Revised Short Form: Pediatric
Measuring the Organization and Delivery of Pediatric … The MHI-Revised Short Form (MHI-RSF) is a subset of 14 items from the MHI. … ____________________
Email: _______________________________
Who took the lead in completing this form … Name (if different than the person who completed this form): ___________________________
Title/Position
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www.innovations.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/learn-from-defects-fac-guide.html
July 01, 2023 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … The Learn From Defects Form, which provides a standardized means to assess where defects occur and to … Sensemaking tools include—
Discovery Form.
Root Cause Analysis. … Further guidance to complete this exercise can be found using the CUSP Learn From Defects form. … Keep project leaders apprised of the information on this form.