CRCCP Clinic-level Collection

Colorectal Cancer Control Program (CRCCP) Monitoring Activities

Attachment 4a - CRCCP Clinic-Level Collection Instrument (screenshots)

CRCCP Clinic-level Information Collection

OMB: 0920-1074

Document [pdf]
Download: pdf | pdf
ATTACHMENT 4A: CRCCP Clinic-Level Collection Instrument (Screenshots)
Welcome Screen

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 1 of 13

Health System Data

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 2 of 13

Clinic Data - Characteristics

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 3 of 13

Clinic Data – Characteristics, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 4 of 13

Clinic Data - Baseline

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 5 of 13

Clinic Data – Baseline, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 6 of 13

Clinic Data – Baseline, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 7 of 13

Clinic Data – Annual

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 8 of 13

Clinic Data – Annual, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 9 of 13

Clinic Data – Annual, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 10 of 13

Clinic Data – Annual, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 11 of 13

Clinic Data – Annual, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 12 of 13

Clinic Data – Annual, continued

Attachment 4A – CRCCP Clinic-Level Collection Instrument

Page 13 of 13


File Typeapplication/pdf
AuthorHowe, Will (IMS)
File Modified2016-03-09
File Created2016-03-09

© 2024 OMB.report | Privacy Policy