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Tracking and Improving Screening for Colorectal Cancer Intervention: A

Tool 2.b-3 Screening Tracking Sheet for Practices

Patient NamePatient IDDOBFor CX ScreensFor Stool Test ScreensFor Stool Test Positive Screens
CX Results ReceivedPatient Notified of ResultsPatient Returned Stool Test KitStool Test Kit Sent to LabTest Result ReceivedPatient Notified of ResultsResult PositiveCDE Recommended to PatientCDE CompletedCDE Results Received
             
             
             
             
             
             
             
             
             
             
             
             

Key: DOB = date of birth; CX = screening colonoscopy; CDE = complete diagnostic exam (diagnostic colonoscopy).

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Current as of December 2010
Internet Citation: Tracking and Improving Screening for Colorectal Cancer Intervention: A: Tool 2.b-3 Screening Tracking Sheet for Practices. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool2b3.html