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 |
|
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | ICFI |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |