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Tracking and Improving Screening for Colorectal Cancer Intervention: A

Tool 6.a-1 Feedback Form for Stool Test Positive

Colorectal Cancer Screening Feedback Form for FIT Positive Patients

DATE

Below is a list of patients in your practice who participated in the SATIS-PHI/CRC screening program and had a POSITIVE fecal immunochemical test (FIT+) result. The date of the result is included.

Each patient with a POSITIVE FIT (FIT+) result should be referred for complete diagnostic evaluation (CDE) of the colon. CDE options, according to current U.S. Multi-Society Task Force guidelines, include colonoscopy or flexible sigmoidscopy with double-contrast barium enema.

Patient status was determined on the basis of a medical record review and inspection of administrative data. Completion of CDE for each patient is indicated if known.

If you have any questions related to the information provided here, please call our office at [INSERT CONTACT PHONE NUMBER HERE].

Sincerely,

[INSERT NAME OF CONTACT HERE]

Patient NameID NumberFIT+ Result DateCDE Status
    
    
    
    
    
    
    
    
    
    

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Current as of December 2010
Internet Citation: Tracking and Improving Screening for Colorectal Cancer Intervention: A: Tool 6.a-1 Feedback Form for Stool Test Positive. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool6a1.html