OMB control number

Measure Dx: A Resource To Identify, Analyze, and Learn From DiagnosticSafety Events

OMB 0935-0263 · HHS/AHRQ.

OMB 0935-0263

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 8 Appendix H: ECHO Call Protocol	Form and Instruction
Form 8 Appendix H: ECHO Call Protocol	Form and Instruction
Form 7 Appendix G: Case Review Summary Form	Form and Instruction
Form 7 Appendix G: Case Review Summary Form	Form and Instruction
Form 6 Appendix F: Team Questionnaire	Form and Instruction
Form 6 Appendix F: Team Questionnaire	Form and Instruction
Form 5 Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction
Form 5 Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction
Form 4 Appendix D: Pre-Test Interview Protocol	Form and Instruction
Form 4 Appendix D: Pre-Test Interview Protocol	Form and Instruction
Form 3 Appendix C –Safer Dx Checklist	Form and Instruction
Form 3 Appendix C –Safer Dx Checklist	Form and Instruction
Form 2 Appendix B: Organizational Self-Assessment	Form and Instruction
Form 2 Appendix B: Organizational Self-Assessment	Form and Instruction
Form 1 Appendix A – Organizational Characteristics Survey	Form and Instruction
Form 1 Appendix A: Organizational Characteristics Survey	Form and Instruction
0935-newStatement A_Dx_Measurement Resource Full Eval_final_v2 hhs.docx	Supporting Statement A
Appendix H: ECHO Call Protocol	Form and Instruction
Appendix H: ECHO Call Protocol	Form and Instruction
Appendix G: Case Review Summary Form	Form and Instruction
Appendix G: Case Review Summary Form	Form and Instruction
Appendix F: Team Questionnaire	Form and Instruction
Appendix F: Team Questionnaire	Form and Instruction
Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction
Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction
Appendix D: Pre-Test Interview Protocol	Form and Instruction
Appendix D: Pre-Test Interview Protocol	Form and Instruction
Appendix C –Safer Dx Checklist	Form and Instruction
Appendix C –Safer Dx Checklist	Form and Instruction
Appendix B: Organizational Self-Assessment	Form and Instruction
Appendix B: Organizational Self-Assessment	Form and Instruction
Appendix A: Organizational Characteristics Survey	Form and Instruction
Appendix A: Organizational Characteristics Survey	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202208-0935-001	New collection (Request for a new OMB Control Number)	2022-08-31		Approved without change