CRCCP Clinic Baseline and Annual Reporting System (CBARS

Colorectal Cancer Control Program (CRCCP) Monitoring Activities

Att 5a - CRCCP Clinic Data Coll Instmt (screenshots) FINAL

OMB: 0920-1074

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CRCCP Clinic-level Data

NOFO DP20-2002

Example/Draft Data Entry Screens

From CRCCP Clinic Data Dictionary version 5

August 21, 2020





About Page
































Health System












Health System (HS) Baseline



























Health System (HS) Annual



























Clinic Information




























Baseline (part 1 – Clinic CRCCP Activity and Status)














Baseline (part 2 – Clinic CRCCP Activity and Status continued)







































Baseline (part 3 – Health System and Clinic Characteristics and Clinic Patient Population)


Baseline (part 4 – CRC Screening Rates and Practices)











Baseline (part 5 – CRC Screening Rates and Practices continued)

























Baseline (part 6 – CRC Screening Rates and Practices continued)



Baseline (part 7 – Monitoring and Quality Improvement Activities and EBIs and Other Clinic Activities)






Baseline (part 8 – Other Colorectal Cancer Activities and Comments)

































Annual (part 1 – Clinic CRCCP Activity and Status)




















Annual (part 2 – Clinic CRCCP Activity and Status continued)











Annual (part 3 – Health System and Clinic Characteristics and Clinic Patient Population)






















Annual (part 4 – CRC Screening Rates and Practices)

Annual (part 5 – CRC Screening Rates and Practices continued)



















Annual (part 6 – CRC Screening Rates and Practices continued)









Annual (part 7 – CRC Screening Rates and Practices continued)






















Annual (part 8 – Monitoring and Quality Improvement Activities)



Annual (part 9 – EBIs and Other Clinic Activities)





Annual (part 10 – EBIs and Other Clinic Activities continued)











Annual (part 11 – EBIs and Other Clinic Activities continued)

Annual (part 12 – Annual Implementation Factors)





Annual (part 13 – Other Colorectal Cancer Activities and Comments)



Attachment 5a – Clinic-Level Data Collection Instrument Page 14 of 14


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AuthorShort, Will (IMS)
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File Created2021-05-05

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