Tracking and Improving Screening for Colorectal Cancer Intervention: A

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
Patient Name	Patient ID	DOB	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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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