The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use

ICR 202303-0935-001

OMB: 0935-0265

Federal Form Document

Forms and Documents

Document Name	Status
Form 11 Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort Form and Instruction	New
Form 10 Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Form and Instruction	New
Form 8 Interview Guide for Semi-Structured Interviews Form and Instruction	New
Form 7 Participant Experience Survey_Antibiotic Stewardship Cohort Form and Instruction	New
Form 6 Participant Experience Survey_Cancer Diagnostic Process Cohort Form and Instruction	New
Form 5 Diagnostic Safety Supplement Form and Instruction	New
Form 4 The Medical Office Survey on Patient Safety Culture (MOSOPS) Form and Instruction	New
Form 3 The Office Readiness Survey_Cancer Diagnostic Process Cohort Form and Instruction	New
Form 1 Structural Assessments Form and Instruction	New
Supporting Statement A.docx Supporting Statement A	2023-03-16
Att N_Schedule of Assessment Activities, 2022-2026.docx Supplementary Document	2023-03-09
Supporting Statement B .docx Supporting Statement B	2023-03-06

IC Document Collections

IC ID	Document Title	Status
258926	Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort Form and Instruction	New
258925	Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Form and Instruction	New
258922	Interview Guide for Semi-Structured Interviews Form and Instruction	New
258921	Participant Experience Survey_Antibiotic Stewardship Cohort Form and Instruction	New
258920	Participant Experience Survey_Cancer Diagnostic Process Cohort Form and Instruction	New
258919	Diagnostic Safety Supplement Form and Instruction	New
258916	The Medical Office Survey on Patient Safety Culture (MOSOPS) Form and Instruction	New
258915	The Office Readiness Survey_Cancer Diagnostic Process Cohort Form and Instruction	New
258913	Structural Assessments Form and Instruction	New