Health Literacy Universal Precautions Toolkit, 2nd Edition

Appendix Items

Tools to Start on the Path to Improvement

Tool 2: Create a Health Literacy Improvement Plan

Primary Care Health Literacy Assessment  [ Microsoft Word file Microsoft Word version - 39.95 KB ]
Plan, Do, Study, Act (PDSA) Directions and Examples  [ Microsoft Word file Microsoft Word: PSDA Worksheet - 21.79 KB ]

Tool 3: Raise Awareness

Health Literacy: Hidden Barriers and Practical Strategies 
Health Literacy Video: Questions for Discussion 
Health Literacy Video: Moderator's Guide 
Health Literacy Brief Assessment Quiz  [ Microsoft Word file Microsoft Word version - 29.78 KB ]

Tools to Improve Spoken Communication

Tool 4: Communicate Clearly

Key Communication Strategies Poster  [ Microsoft Word file Microsoft Word version - 18.56 KB
Communication Self-Assessment  [ Microsoft Word file Microsoft Word version - 21.55 KB
Communication Observation Form   [ Microsoft Word file Microsoft Word version - 20.59 KB ]
Brief Patient Feedback Form   [ Microsoft Word file Microsoft Word version - 20.78 KB ]

Tool 6: Follow Up with Patients

Followup Instruction Form for a Patient with Diabetes [ PDF file PDF version - 96.13 KB ]

Tool 7: Improve Telephone Access

Sample Automated Telephone System Menu [ PDF file PDF version - 198 KB ]

Tool 8: Conduct Brown Bag Medicine Reviews

Medicine Review Poster  [ Microsoft Word file Microsoft Word version - 42.76 KB ]
Medicine Review Form  [ Microsoft Word file Microsoft Word version - 24.61 KB ]

Tools to Improve Written Communication

Tool 11: Assess, Select, and Create Easy-to-Understand Materials

Adult Initial Health History Form  [ Microsoft Word file Microsoft Word version - 75.5 KB
Young Child Health History Form  [ Microsoft Word file Microsoft Word version - 76 KB
Adult Return Visit Update Form  [ Microsoft Word file Microsoft Word version - 22.27 KB
Consent to Treat Form  [ Microsoft Word file Microsoft Word version - 21.89 KB
Release of Medical Information  [ Microsoft Word file Microsoft Word version - 24.99 KB
Lab Results Letter  [ Microsoft Word file Microsoft Word version - 18.9 KB
Appointment Reminder  [ Microsoft Word file Microsoft Word version - 49.8 KB ]

Tools to Improve Self-Management and Empowerment

Tool 14: Encourage Questions

Brief Patient Feedback Form  [ Microsoft Word file Microsoft Word version - 23.61 KB; PDF file PDF version - 380.37 KB ]

Tool 15: Make Action Plans

My Action Plan in English and Spanish [ PDF file PDF version - 581.84 KB]

Tool 16: Help Patients Remember How and When to Take Their Medicine

My Medicines Form   [ Microsoft Word file Microsoft Word version - 43.46 KB
Medicine Reminder Form  [ Microsoft Word file Microsoft Word version - 111.76 KB
Medicine Aid Poster  [ Microsoft Word file Microsoft Word version - 184.26 KB ]

Tool 17: Get Patient Feedback

Navigating the Health Care System 
Patient Portal Feedback Form  [ Microsoft Word file Microsoft Word version - 24.42 KB
Suggestion Box Poster  [ Microsoft Word file Microsoft Word version - 18.59 KB
Health Literacy Patient Survey  [ Microsoft Word file Microsoft Word version - 30.79 KB
Sample Cover Letter  [ Microsoft Word file Microsoft Word version - 20.84 KB ]

Tools to Improve Supportive Systems

Tool 18: Link Patients to Non-Medical Support

Community Referral Form [ PDF file PDF version - 533.54 KB ]

Tool 20: Connect Patients with Literacy and Math Resources

Example Community Referral Form  [ Microsoft Word file Microsoft Word version - 22.51 KB; PDF file PDF version - 480.46 KB ]

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Page last reviewed February 2016
Page originally created February 2015
Internet Citation: Appendix Items. Content last reviewed February 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-apitems.html