Alcohol Prescreening Questionnaire

A series of questions to be included in a patient previsit questionnaire designed to screen for potential risky drinking behavior

Download Format: PDF

Source Article

Chart Prep Questionnaire

A patient questionnaire that helps nursing staff ensure that recent clinical reports and data are collected in the patient's chart

Download Format: PDF

Source Article

Diabetes Assessment Form

An annual questionnaire that helps patients with diabetes think about their health care goals and identify areas in which they may need assistance

Download Format: PDF

Source Article

HCA Patient Education Form

A checklist to help prepare patients for advance care planning conversations, starting with selecting a health care agent

Tool as published

Source Article

Health Confidence Measure

A tool for assessing patients' confidence in their ability to control and manage their health problems

Download Format: PDF

Source Article

Health Risk Assessment/Medicare Wellness Checkup

A health risk assessment Medicare patients can complete as part of their annual wellness visits

Download Format: PDF

Source Article

Patient Satisfaction Survey

A sample survey practices can use to measure patient satisfaction

Download Format: PDF

Source Article

Phone System Survey

A survey that asks patients to evaluate the efficiency of a practice's phone system

Download Format: PDF

Source Article

Pre-Visit Questionnaire

A list of questions the patient completes on paper in the waiting room or through an online patient portal from home

Download Format: PDF

Source Article

Social Needs: Patient Questionnaire

An 11-question tool to help practices screen for social determinants of health

Download Format: PDF

Source Article

Today's Visit Checklist

A brief checklist for patients that helps them focus their goals for the current visit

Download Format: PDF

Source Article