OMB control number

Health Care Systems for Tracking Colorectal Cancer Screening Tests

OMB 0935-0146 · HHS/AHRQ.

OMB 0935-0146

Latest Forms, Documents, and Supporting Material

Document Name
Form Form #13 Patient Focus Groups (post-intervention) Form and Instruction
Form Form #12 Chart audits Form and Instruction
Form Form #11 Control survey of clinicians and staff Form and Instruction
Form Form #10 Post-intervention survey of clinicians and staff Form and Instruction
Form Form #9 Pre-intervention survey of clinicians and staff Form and Instruction
Form Form #8 Control informal interviews with selected providers and staff Form and Instruction
Form Form #7 Post-intervention informal interviews with selected providers and staff Form and Instruction
Form Form #6 Pre-intervention informal interviews with selected providers and staff Form and Instruction
Form Form #5 Control practice focus groups Form and Instruction
Form Form #4 Post-intervention practice focus groups Form and Instruction
Form Form #3 Pre-intervention practice focus groups Form and Instruction
Form Form #2 Screening Eligibility Assessment (SEA) Form Form and Instruction
Form Form #1 Electronic patient record review Form and Instruction
CRC omb passback.doc Supplementary Document
Attachment C3_Brief Informal Interviews with Selected Providers and Staff at Each Practice.doc Supplementary Document
Attachment C2_Focus group of providers and staff at each intervention and control practice.doc Supplementary Document
Attachment C6_Patient Focus Groups.doc Supplementary Document
Attachment C5_Patient Chart Audits.doc Supplementary Document
Attachment C7_Electronic Records Review Eligibility Criteria.xls Supplementary Document
Attachment C4_A survey of all clinicians and staff at each practice - FINALv2.doc Supplementary Document
Attachment C1_A Screening Eligibility (SEA) Form - FINALv2.doc Supplementary Document
Supporting Statement Part B - FINAL Resubmit - 10-28-2008.doc Supporting Statement B
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document
Attachment B_60 Day FRN -- Healthcare Systems for Tracking Colorectal Cancer Screening Tests.pdf Supplementary Document
Attachment D5_Patient Consent.doc Supplementary Document
Attachment D4_ Practice consent.doc Supplementary Document
Attachment D3_ Patient Reminder Letter.doc Supplementary Document
Attachment D2_ Patient Invitation Letter.doc Supplementary Document
Attachment D1_Screening Elibility Letter.doc Supplementary Document
Supporting Statement Part A - FINAL Resubmit - 10-28-2008.doc Supporting Statement A
Patient Focus Groups (post-intervention) Form and Instruction
Chart audits Form and Instruction
Control survey of clinicians and staff Form and Instruction
Post-intervention survey of clinicians and staff Form and Instruction
Pre-intervention survey of clinicians and staff Form and Instruction
Control informal interviews with selected providers and staff Form and Instruction
Post-intervention informal interviews with selected providers and staff Form and Instruction
Pre-intervention informal interviews with selected providers and staff Form and Instruction
Control practice focus groups Form and Instruction
Post-intervention practice focus groups Form and Instruction
Pre-intervention practice focus groups Form and Instruction
Screening Eligibility Assessment (SEA) Form Form and Instruction
Electronic patient record review Form and Instruction

All Historical Document Collections

200807-0935-002

Approved with change

New collection (Request for a new OMB Control Number)

2008-07-30