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Verbal Implementation Flow Model

You can use or modify this sample flow model when you are tracking Decision Aids:
  1. Patient identified as “eligible” by Medical Assistant rooming patient.
  2. MA will start DA Data Collection Form (complete mid section-Numerator Data tracking:  DA DVD Distribution & Viewing Questionnaire). If the provider identifies the patient he or she informs the MA.
  3. MA will put label (Patient ID#) on Data Collection Form and put label (Patient ID#) on questionnaire and label (Patient ID#) on DVD Case.  MA will write the patient’s name on the DA Collection form.
  4. MA will put DA DVD and questionnaire with the self addressed stamped envelope on Clinician’s Computer.
  5. Clinician will hand out DA packet if appropriate and document under Intervention:  Sample-DA CCS given (DA Colon Cancer Screening). If Clinician does not want to distribute DVD to patient, he/she will mark under the Denominator Data Tracking Section the reason(s) that apply.
  6. DA Collection Form will be given to the Front Desk Staff by the MA.  This form can be given to the patient with the fee slip to be brought to the front desk.
  7. Front Desk will enter data on the printed excel sheet and file DA Collection Form.
  8. Front Desk will use Outlook Reminder Calendar and flag a two week follow up call.
  9. Front desk will make reminder phone call if necessary and list on Decision Aid Data Collection Form that a call was made.
  10. A reminder postcard will be sent one week after the first reminder phone call if the DVD/Questionnaire is not returned. The front desk will obtain the postcard from the provider’s MA.
  11. DVD and questionnaire will be returned (mailed or brought back by patient).
  12. Front Desk will pull DA Data Collection Form and complete the lower half (Return of DA/Questionnaire)
  13. Front Desk Staff will delete reminder phone call if DVD returned.

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