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

2. Section1-Appendix1-A-Permission-Forms (doc file)
   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.

3. 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

4. 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.

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

6. Community-Referral-Form (doc file)
   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. Medicine-Review-Form (doc file)
   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.

8. Talent Release Form (pdf file)
   www.ahrq.gov/sites/default/files/wysiwyg/research/publications/pubcomguide/Talent-Release-fillable-form.pdf
   April 01, 2024 - Talent Release Form Talent Release Form Instructions This Talent Release Form must be completed … Completed release forms are recommended for people whose video appearances are possible but uncertain … Talent Release Form. … This form may be used for other types of production if the Type of Product is specified below. … Unless the participating minor cannot write, the minor also must sign the release form.]

9. 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

10. 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

11. Forms and Electronic Applications | Agency for Healthcare Research and Quality
    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

12. Chart Abstraction Form (pdf file)
    www.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. Self-Assessment Form (pdf file)
    www.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

14. Coaching Feedback Form (pdf file)
    www.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

15. Form I. Patient Consent Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/resources/resdesign-tool/tkformi.html
    August 01, 2016 - Definitions Form A. Site Visit/Conference Call Questions Form B. … Employee Focus Group Questions Form C. … Patient/Family Focus Group Consent Form Form F. Staff Process Flow Observation Form Form G. … Patient Process Flow Observation Form Form H. Staff Member Consent Form Form I. … I will get a copy of this consent form. Initial all the previous pages of consent form.

16. Thrombosis | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/thrombosis.html
    Topic: Thrombosis Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body

17. Inclusive Language for Intake Forms | Agency for Healthcare Research and Quality
    www.ahrq.gov/health-literacy/improve/precautions/tool11h.html
    March 01, 2024 - Health Literacy Universal Precautions Toolkit, 3rd Edition Inclusive Language for Intake Forms … Insurance Release of Medical Information Appointment Reminder Letter Inclusive Language for Intake Forms … also available in Word (16 KB) Below are examples of language you could use on your patient intake forms … Checkbox Alternatives Checkboxes are commonly used in forms that are completed electronically. … Even on paper forms, checkboxes make data entry easier.

18. Action-Plan-Form-Example (doc file)
    www.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.

19. TeamSTEPPS Coaching Feedback Form (pdf file)
    www.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

20. TeamSTEPPS Training Evaluation Form (pdf file)
    www.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