Form #4 Form #4 Example Screen Shots of Web Site Information Collection

AHRQ Medical Office Survey on Patient Safety Culture Comparative Database, Supporting Statement B

Attachment G: Example Screen Shots of Medical Office Survey on Patient Safety Culture Data Submission Web Site Information Collection

Figure 1: Submit Questionnaire and Link Questionnaire to Medical Office(s)

Figure 1: Submit Questionnaire and Link Questionnaire to Medical Office(s), continued

Figure 2: Upload Data for Each Participating Medical Office

Figure 2: Upload Data for Each Participating Medical Office, continued