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  1. pso.ahrq.gov/forms
    February 01, 2022 - SHARE: More topics in this section FormsForms Initial Listing Certification Forms Patient Safety Organizations … (PSOs) are encouraged to complete and submit forms online. … Forms can also be downloaded for completion and emailed or mailed. … https://pso.ahrq.gov/forms   Back to Top
  2. www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/inclusive-language-intake-forms.docx
    March 14, 2024 - Inclusive Language for Intake Forms Below are examples of language you could use on your patient intake … forms to ensure an inclusive and affirming patient experience. … about “blood relatives” rather than “family.” · Checkbox Alternatives Checkboxes are commonly used in forms … Even on paper forms, checkboxes make data entry easier.
  3. www.ahrq.gov/sites/default/files/wysiwyg/research/publications/pubcomguide/section1-appendix1-a-permission-forms.docx
    March 18, 2021 - Permission Forms This appendix contains: Permission Form for AHRQ To Use Copyrighted Material Release … if they do not have forms of their own; however, grantees are not required to use these versions, nor … Note: Delete instructions (e.g., INSERT NAME, Return to Top) when finalizing the forms. … Some publishers have their own forms to request use of copyrighted materials. … Provide copies of signed forms to the managing editor.
  4. Action-Plan-Form (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form.docx
    March 01, 2024 - Action Plan Form My visit with: Date: What I want to do for my health: |_| Eat better
  5. www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/medicine-review-form.docx
    March 01, 2024 - Medicine Review Form Patient Name/ Number: _____________________________________________ Date: _ … Thank you for completing this form. You are now done. 9.
  6. www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/community-referral-form.docx
    March 01, 2024 - Community Referral Form: [Practice Name] Reason for Referral_________________________________ Name of … _____________________________________________________________________ Example Community Referral Form … Community Referral Form: City Medical Care Reason for Referral Education Classes Name of Program
  7. Patient-Portal-Form (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/patient-portal-form.docx
    March 01, 2024 - Patient Portal Feedback Form Instructions: These questions are meant to guide your collection of feedback … After they are done, ask the following questions and use this form to record responses. 1.
  8. www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/communication-observation-form.docx
    March 01, 2024 - Communication Observation Form Please observe the interaction between a patient and a clinician.
  9. Pemat Form (xls file)

    www.ahrq.gov/sites/default/files/publications/files/pemat_form.xls
    November 01, 2013 - PEMAT Patient Education Materials Assessment Tool (PEMAT) Auto-Scoring Form   An Instrument To … You may refer to the material at any time while you complete the form. … This PEMAT Auto-Scoring Form automatically calculates an overall understandability and actionability
  10. Pemat Form (xls file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat_form.xls
    November 01, 2013 - PEMAT Patient Education Materials Assessment Tool (PEMAT) Auto-Scoring Form   An Instrument To … You may refer to the material at any time while you complete the form. … This PEMAT Auto-Scoring Form automatically calculates an overall understandability and actionability
  11. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/inclusive-language-intake-forms.docx
    March 14, 2024 - Inclusive Language for Intake Forms Below are examples of language you could use on your patient intake … forms to ensure an inclusive and affirming patient experience. … about “blood relatives” rather than “family.” · Checkbox Alternatives Checkboxes are commonly used in forms … Even on paper forms, checkboxes make data entry easier.
  12. www.ahrq.gov/funding/process/app-forms/index.html
    November 01, 2015 - Forms and Electronic Applications Grant Application Forms Sign up: Grants Review Process … change from paper to electronic filing, the current PHS 398 application will be replaced by the Standard Form … For additional information on electronic grant applications, please go to Forms and Electronic Applications … 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
  13. effectivehealthcare.ahrq.gov/sites/default/files/epc-disclosure-policy-form.pdf
    March 01, 2023 - Although the logistics of gathering COI disclosure forms may be delegated to a project manager, the … Although the logistics of gathering the COI disclosure forms may be delegated to a project manager, … The EPC should update Disclosure Forms for any individual whose involvement in the projects extends … The EPC should maintain the Disclosure Forms for 6 years past delivery of the final report. … The EPC should maintain the Disclosure Forms for 6 years past delivery of the final report.  
  14. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/communication-observation-form.docx
    March 01, 2024 - Communication Observation Form Please observe the interaction between a patient and a clinician.
  15. Action-Plan-Form (doc file)

    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form.docx
    March 01, 2024 - Action Plan Form My visit with: Date: What I want to do for my health: |_| Eat better
  16. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/medicine-review-form.docx
    March 01, 2024 - Medicine Review Form Patient Name/ Number: _____________________________________________ Date: _ … Thank you for completing this form. You are now done. 9.
  17. Action-Plan-Form (doc file)

    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form.docx
    March 01, 2024 - Action Plan Form My visit with: Date: What I want to do for my health: |_| Eat better
  18. Patient-Portal-Form (doc file)

    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/patient-portal-form.docx
    March 01, 2024 - Patient Portal Feedback Form Instructions: These questions are meant to guide your collection of feedback … After they are done, ask the following questions and use this form to record responses. 1.
  19. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/communication-observation-form.docx
    March 01, 2024 - Communication Observation Form Please observe the interaction between a patient and a clinician.
  20. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/community-referral-form.docx
    March 01, 2024 - Community Referral Form: [Practice Name] Reason for Referral_________________________________ Name of … _____________________________________________________________________ Example Community Referral Form … Community Referral Form: City Medical Care Reason for Referral Education Classes Name of Program