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Tracking and Improving Screening for Colorectal Cancer Intervention: A

6.b-1 Feedback Form for CDE

Complete Diagnostic Evaluation (CDE)* of the Colon as Followup to a Positive Fecal Immunochemical Test

Listed below are the names of your patients who had a recent positive fecal immunochemical test (FIT+) when screened for colorectal cancer. We previously notified you that these patients were FIT+ and reminded you that the U.S. Multi-Society Task Force guidelines recommend a complete diagnostic evaluation (CDE) of the colon with either colonoscopy (Cx) or a combination of flexible sigmoidoscopy plus double contrast barium enema (FS+BE) as followup. We ask that you complete this form with as much information as you currently have about the CDE for each of these patients.

Use the Comments column at the right to indicate any special circumstances as to why a CDE was not recommended or scheduled.

All dates should follow MM/DD/YYYY format.

Patient NameDate CDE
Recommended
CDE Modality
Recommended
(Cx/FS/BE)
Date CDE
Scheduled
Date CDE
Completed
CDE
Results
(Normal/ Abnormal)
Comments
       
       
       
       
       
       

After Completing This Form, Please Return It To:

[INSERT RETURN ORGANIZATION NAME, ADDRESS, AND CONTACT INFORMATION]

* Recommended procedures for CDE include (1) colonoscopy or (2) flexible sigmoidoscopy plus double-contrast barium enema.

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Page last reviewed December 2010
Internet Citation: Tracking and Improving Screening for Colorectal Cancer Intervention: A: 6.b-1 Feedback Form for CDE. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool6b1.html