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Tracking and Improving Screening for Colorectal Cancer Intervention: A

Tool 6.a-2 Feedback Form for Stool Test Negative

Colorectal Cancer Screening Feedback Form for FIT Negative Patients

DATE

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

Patient status was determined on the basis of a medical record review and inspection of administrative data.

All patients with a NEGATIVE FIT (FIT-) result should be notified of this result and informed that the U.S. Multi-Society Task Force guidelines recommend that they should be rescreened every 12 months.

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

Sincerely,

[INSERT HERE: CONTACT NAME

Patient NameID NumberFIT+ Result DateCDE Status
    
    
    
    
    
    
    
    
    
    

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Page last reviewed December 2010
Internet Citation: Tracking and Improving Screening for Colorectal Cancer Intervention: A: Tool 6.a-2 Feedback Form for Stool Test Negative. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool6a2.html