OMB control number

Patient-Reported Health Information Technology and Workflow

OMB 0935-0212 · HHS/AHRQ.

OMB 0935-0212

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form #8 Post Visit Follow-up to Review the Workflow Process Map(s)	Form and Instruction
Form Form #7 Patient Interviews	Form and Instruction
Form Form #6 Survey of Clinicians and Office Staff	Form and Instruction
Form Form #5 Interviews with Clinicians and Office Staff	Form and Instruction
Form Form #4 Interviews with Practice Manager and Physician Leader	Form and Instruction
Form Form #3 Practice Tour	Form and Instruction
Form Form #2 Pre-Visit Questionnaire	Form and Instruction
Form Form #1 Preliminary Conference Call	Form and Instruction
SS Part B -- Patient-Reported Health IT and Workflow.docx	Supporting Statement B
Attachment S -- Information Sheet for Patient Observations.docx	Supplementary Document
Attachment N -- List of Subcontractor Practices.docx	Supplementary Document
Attachment M -- Federal Register Notice.pdf	Supplementary Document
Attachment F -- Observation Form.docx	Supplementary Document
Attachment K -- Email for Follow-Up.docx	Supplementary Document
Attachment R -- Information Sheet for Patient Interviews and Observations.docx	Supplementary Document
Attachment H -- Clinician and Office Staff Survey Invitation.docx	Supplementary Document
Attachment H -- Clinician and Office Staff Survey Invitation.docx	Supplementary Document
Attachment Q -- Information Sheet for Office Staff.docx	Supplementary Document
Attachment P -- Information Sheet for Clinicians.docx	Supplementary Document
Attachment P -- Information Sheet for Clinicians.docx	Supplementary Document
Attachment O -- Information Sheet for Practice Managers.docx	Supplementary Document
SS Part A -- Patient-Reported Health IT and Workflow.doc	Supporting Statement A
Post Visit Follow-up to Review the Workflow Process Map(s)	Form and Instruction
Patient Interviews	Form and Instruction
Survey of Clinicians and Office Staff	Form and Instruction
Interviews with Clinicians and Office Staff	Form and Instruction
Interviews with Practice Manager and Physician Leader	Form and Instruction
Practice Tour	Form and Instruction
Pre-Visit Questionnaire	Form and Instruction
Preliminary Conference Call	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201305-0935-001	New collection (Request for a new OMB Control Number)	2013-05-13		Approved without change