OMB control number

Patient-Reported Health Information Technology and Workflow

OMB 0935-0212 · HHS/AHRQ.

OMB 0935-0212

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

201305-0935-001

Approved without change

New collection (Request for a new OMB Control Number)

2013-05-13