Tracking and Improving Screening for Colorectal Cancer Intervention

Tool 2.b-3 Screening Tracking Sheet for Practices

Patient Name Patient ID DOB For CX Screens For Stool Test Screens For Stool Test Positive Screens
CX Results Received Patient Notified of Results Patient Returned Stool Test Kit Stool Test Kit Sent to Lab Test Result Received Patient Notified of Results Result Positive CDE Recommended to Patient CDE Completed CDE Results Received
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         

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

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Page last reviewed October 2014
Internet Citation: Tool 2.b-3 Screening Tracking Sheet for Practices. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool2b3.html