Module 15 Appendix B

Sample Practice Record

Encounter Notes

Screenshot of Excel workbook page.

Baseline Performance Data

Excel spreadsheet showing performance data, including lab results, adherence to recommended labs, preventive measures, such as flu vaccine, medications, such as metformin,  CKD on problem list, and demographic data.

Performance Run Data Chart

Screenshot of Excel workbook page.

Return to Module 15

Page last reviewed May 2013
Internet Citation: Module 15 Appendix B: Sample Practice Record. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod15appendixb.html