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1. Inclusive-Language-Intake-Forms (doc file)
   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.

2. Community-Referral-Form (doc file)
   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

3. Medicine-Review-Form (doc file)
   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.

4. Communication-Observation-Form (doc file)
   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.

5. 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.

6. 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

7. Pemat Form (xls file)
   ce.effectivehealthcare.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

8. Pemat Form (xls file)
   ce.effectivehealthcare.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

9. Forms and Electronic Applications | Agency for Healthcare Research and Quality
   ce.effectivehealthcare.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

10. Self-Assessment Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_selfasst.pdf
    April 24, 2017 - Self-Assessment Form Coaching Workshop ASTD Coaching Self-Assessment Form INSTRUCTIONS … TeamSTEPPS 2.0 for Long-Term Care ASTD Coaching Self-Assessment Form – D-9-31 Coaching Workshop … ASTD Coaching Self-Assessment Form – D-9-32 TeamSTEPPS 2.0 for Long-Term Care Coaching Workshop … TeamSTEPPS 2.0 for Long-Term Care ASTD Coaching Self-Assessment Form – D-9-33 Coaching Workshop … ASTD Coaching Self-Assessment Form – D-9-34 TeamSTEPPS 2.0 for Long-Term Care

11. Coaching Feedback Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_feedback.pdf
    April 24, 2017 - Coaching Feedback Form Coaching Workshop Coaching Feedback Form INSTRUCTIONS: While observing … the scripted coaching practice exercise, use this form to document the demonstrated competencies of … particular scenario, and the observer watches the interaction and notes on the coaching observation form … Responding to Requests Following Through TeamSTEPPS 2.0 for Long-Term Care Coaching Feedback Form

12. Chart Abstraction Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-203-section-2-tech-specs.pdf
    December 14, 2011 - Chart Abstraction Form Basic Elements Patient ID Race Ethnicity Gender … 14 15 16 17 18 19 20 21 22 23 lad895 Typewritten Text Attachment 2.1 Chart Abstraction Form

13. Inclusive Language for Intake Forms | Agency for Healthcare Research and Quality
    ce.effectivehealthcare.ahrq.gov/health-literacy/improve/precautions/tool11h.html
    March 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Health Literacy Universal Precautions Toolkit, 3rd Edition Inclusive Language for Intake Forms … Key Strategies for Clear Communication Communication Self-Assessment Communication Observation Form … Checkbox Alternatives Checkboxes are commonly used in forms that are completed electronically. … Even on paper forms, checkboxes make data entry easier.

14. TeamSTEPPS Coaching Feedback Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-coaching-feedback-form.pdf
    May 31, 2023 - TeamSTEPPS Coaching Feedback Form Coaching Feedback Form INSTRUCTIONS While observing the scripted … coaching practice exercise, use this form to document the demonstrated competencies of the designated … particular scenario, and the observer watches the interaction and notes on the coaching observation form … Difficult Situations Execution Responding to Requests Following Through Coaching Feedback Form

15. TeamSTEPPS Training Evaluation Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-course-evaluation-form.pdf
    June 01, 2023 - TeamSTEPPS Training Evaluation Form TeamSTEPPS Training Evaluation Form The TeamSTEPPS … course evaluation form that follows is designed for a 2 day course based on the TeamSTEPPS curriculum … include all the material covered in a 2 day course, you may need to remove sections of the evaluation form … TeamSTEPPS Training Evaluation Form 2 Location: ___________________________ Date: __________ … Additional Comments: TeamSTEPPS Training Evaluation Form

16. Action-Plan-Form-Example (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/action-plan-form-example.docx
    August 25, 2023 - Action Plan Form Example My visit with: Dr.

17. ASTD Coaching Self-Assessment Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/astd-coaching-self-assessment-form.pdf
    May 31, 2023 - ASTD Coaching Self-Assessment Form … ASTD Coaching Self-Assessment Form Instructions … ☐ ☐ ☐ ☐ ASTD Coaching Self-Assessment Form 2 … ASTD Coaching Self-Assessment Form 4 … Reference: Chen, Chris, Coaching Training, ASTD, 2003 ASTD Coaching Self-Assessment Form 6 ASTD

18. CAHPS Data Research Abstract Form (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/data-research/cahps-data-research-abstract-form.pdf
    January 01, 2024 - CAHPS Data Research Abstract Form CAHPS Database Research Abstract Form – January 2024 1 Agency for … Healthcare Research and Quality (AHRQ) CAHPS® Database Research Abstract Form Instructions Please … use this form to describe the research for which you require AHRQ Consumer Assessment of Healthcare … Save this completed form with your last name in the file name (e.g., “Smith CAHPS Research Abstract.doc … CAHPS Database Research Abstract Form – January 2024 2 Methodology [Specify measures and proposed

19. Easy-To-Understand-Telehealth-Consent-Form (doc file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/easy-to-understand-telehealth-consent-form.docx
    April 15, 2020 - .] · It will be as if you never signed this form. How much does a telehealth visit cost?  … Do not sign this form until you start your first telehealth visit.

20. CAHPS Data Research Abstract Form Example (pdf file)
    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/data-research/example-cahps-data-research-abstract-form.pdf
    January 01, 2024 - CAHPS Data Research Abstract Form Example CAHPS Database Research Abstract Form – January 2024 1 … Agency for Healthcare Research and Quality (AHRQ) CAHPS® Database Research Abstract Form EXAMPLE … OF A COMPLETED FORM This completed abstract presents an example of how to complete this form. … Abstract Form. … CAHPS Database Research Abstract Form – January 2024