Att 9 - Document Review

ATT 9 Document Review Form.docx

Impact Evaluation of CDC's Colorectal Cancer Control Program

Att 9 - Document Review

OMB: 0920-0992

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Attachment 9


Document Review Form for Case Studies
































CRCCP Case Studies: Document Review Form


I. Document Info

State name


Document name/date


Date reviewed


Reviewer’s initials


II. History/Background of the Program


III. Description of Current Activities

Screening promotion

Description of activities and partnership (e.g. promotion of patient navigation)

Screening provision

Description of activities and partner involvement if appropriate Type (convene MAB, recruit for screening, enroll in insurance programs, etc.)

Policy change

Description of activities

Data collection and evaluation

Description of activities

Program integration

Description of activities

Healthcare reform

Description of activities

FOBT/FIT

Description of strategies to implement, measures of effectiveness, brand of test, other related information

Challenges encountered

Description of activity, challenge and how handled

Facilitators encountered

Description of activity, facilitator and how it helped

IV. Description of Planned Activities

Screening promotion

Description of activities and partnership (e.g. promotion of patient navigation)

Screening provision

Description of activities and partner involvement if appropriate Type (convene MAB, recruit for screening, enroll in insurance programs, etc.)

Policy change

Description of activities

Data collection and evaluation

Description of activities

Program integration

Description of activities

Healthcare reform

Description of activities

FOBT/FIT

Description of strategies to implement, measures of effectiveness, brand of test, other related information

Challenges anticipated

Description of activity, challenge and how handled

Facilitators anticipated

Description of activity, facilitator and how it helped

V. Additional Notes














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AuthorICFI
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