Att 9 - Document Review

Attachment 9

Document Review Form for Case Studies

CRCCP Case Studies: Document Review Form

I. Document Info
State name
Document name/date
Date reviewed
Reviewer’s initials
II. History/Background of the Program
III. Description of Current Activities
Screening promotion	Description of activities and partnership (e.g. promotion of patient navigation)
Screening provision	Description of activities and partner involvement if appropriate Type (convene MAB, recruit for screening, enroll in insurance programs, etc.)
Policy change	Description of activities
Data collection and evaluation	Description of activities
Program integration	Description of activities
Healthcare reform	Description of activities
FOBT/FIT	Description of strategies to implement, measures of effectiveness, brand of test, other related information
Challenges encountered	Description of activity, challenge and how handled
Facilitators encountered	Description of activity, facilitator and how it helped
IV. Description of Planned Activities
Screening promotion	Description of activities and partnership (e.g. promotion of patient navigation)
Screening provision	Description of activities and partner involvement if appropriate Type (convene MAB, recruit for screening, enroll in insurance programs, etc.)
Policy change	Description of activities
Data collection and evaluation	Description of activities
Program integration	Description of activities
Healthcare reform	Description of activities
FOBT/FIT	Description of strategies to implement, measures of effectiveness, brand of test, other related information
Challenges anticipated	Description of activity, challenge and how handled
Facilitators anticipated	Description of activity, facilitator and how it helped
V. Additional Notes