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Assessment of a Pharmacist-Led Transition of Care Service Utilizing an Admissions Enhanced, Patient Risk Evaluation Approach: the ICARE Program CDER
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Instrument: Consent Form Consent Form_PRA 2.8.22.docx Yes Yes Fillable Fileable
Other-Survey Instrument: Pre-implementation Provider Perception and Demand Survey Pre-implementation Provider Perception and Demand Survey 2.2.22.docx Yes Yes Fillable Fileable
Other-Survey Instrument: 12- and 18-month Provider Survey 12- and 18-month Provider Survey 2.8.22.docx Yes Yes Fillable Fileable
Other-Other: Signed IRB Approval Provider Perception EAMC IRB approval_signed.pdf No   Printable Only

Health Health Care Services

 

150 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 450 0 0 0 0 450
Annual IC Time Burden (Hours) 37 0 0 0 0 37
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0847 OMB Approval Memo - Assessment of a Pharmacist-Led Transitions of Care Services Utilizing an Admissions Enhanced Patient Risk Evaluation Approach: the ICARE Program OMB Memo 0847 Assessment Pharmacist Led TOC_2.10.22.docx 02/10/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.