Form G. Patient Process Flow Observation Form

A Toolkit for Redesign in Health Care: Final Report

Note: Complete each field as necessary based on the experience of the patient.

Observer Name: ___________________________ Department/Area: ___________________________   Page: ___ of ___

Date:  ____/____/____

Patient No.:  (1)  (2) (3)  (4) (5)

Time/Shift: ______________

Activity, CommentsInteracted WithTime StartTime EndDistance Traveled
     
     
     
     
     
     
     
     
     
Current as of September 2005
Internet Citation: Form G. Patient Process Flow Observation Form: A Toolkit for Redesign in Health Care: Final Report. September 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/toolkit/tkformg.html